Simultaneous onset of Crohn's disease and Psoriasis in a Multiple Sclerosis patient treated with Teriflunomide: A novel case report highlighting potential autoimmune interactions.

Teriflunomide (TFN) is an oral Disease-modifying therapy (DMT) widely used in the treatment of relapsing forms of Multiple Sclerosis (MS). Although TFN has demonstrated efficacy in reducing MS activity, recent evidence suggests a possible association between TFN and the onset of rare and severe medical conditions. We present a novel case report of a 47-year-old woman with a history of MS who developed concurrent Crohn's disease and Psoriasis following TFN treatment. This unique occurrence has not been previously documented in the literature. The patient experienced gastrointestinal symptoms and changes in nail color while on TFN. Colonoscopy and biopsy revealed crypt architectural distortion and lamina propria expansion, indicative of Crohn's disease, while dermatological evaluation suggested Psoriasis. Consequently, TFN was discontinued and switched to alternative therapy (Glatiramer acetate), and the patient underwent close observation and regular evaluations. Three months after stopping the TFN, the patient's nail lesions disappeared completely, her abdominal pain and diarrhea were resolved, and the follow-up colonoscopy was completely normal. In this regard, the association between MS, Inflammatory Bowel Disease (IBD), and Psoriasis has been reported in previous studies, with potential involvement of Th17 and IL-17 pathways. Although gastrointestinal side effects with TFN use are typically mild and transient, rare cases of TFN-induced IBD have been reported. Dermatological disorders, including Psoriasis, have also been linked to TFN use, with similarities to our case report. Further research and awareness are warranted to better understand the potential side effects and long-term implications of TFN in the management of MS.

Effect of Carob Supplement on Spermogram Parameters and Sexual Function of Infertile Men Referred to the Infertility Center, Hamadan, Iran, 2019: A Randomized Controlled Trial.

Objective: The purpose of this study is comparison of carob with placebo in the treatment of male infertility. Materials and methods: This study was performed as a clinical trial with two-group pretest-posttest design. Each group consisted of 30 members. The first group received 1.5 grams of carob per day, and the second group received placebo treatments. Treatment lasted for 12 weeks. Semen analysis as well as testosterone, prolactin, (LH), (FSH) and (TSH) were performed before and after drug treatment in two groups. Sexual function was assessed in the groups in two stages before and after the intervention using the standard International Index of Erectile Function. P-value less than 0.05 was considered statistically significant. Statistical analysis of data was performed using SPSS 16. Results: The participants' mean age was 34.83 ±6.22 in the placebo and 33.67 ±5.82 years in the Carob group. The results showed in the carob group compared to the placebo group, the rate of normal sperm counts increased by 17% and also the normal level of testosterone was 40% higher than the abnormal levels of the placebo group and these differences were statistically significant (P <0.05). And in most areas of sexual function, the mean scores after the intervention were higher than before (P> 0.05). Conclusion: It is recommended to use carob supplements to improve spermogram parameters and male sex hormones.

Evaluation of serum levels of asprosin and other metabolic profiles in patients with idiopathic tonic-clonic generalized epilepsy on treatment with valproic acid.

BACKGROUND: This cross-sectional research was undertaken to determine the serum levels of asprosin, a novel white adipose tissue-derived glucogenic adipokine, in epileptic patients on valproic acid treatment. METHODS: Sixty-six patients diagnosed with idiopathic tonic-clonic generalized epilepsy were divided into three groups: those treated with valproic acid (n = 22), those treated with lamotrigine (n = 22), and twenty-two newly diagnosed or untreated patients. A control group was twenty-two, healthy volunteers with a similar distribution of gender and age. Body mass index (BMI) and fasting serum levels of asprosin, glucose, glycohemoglobin (HbA1c), insulin, and lipid profile were measured for both patients and control groups. Additionally, homeostasis model assessment for insulin resistance (HOMA-IR) was also calculated for the investigated groups. RESULTS: The mean BMI values and fasting serum levels of glucose, HbA1c, insulin, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and triglyceride were much higher in subjects treated with valproic acid than those in the other study groups. Furthermore, a higher number of participants in the valproic acid group fulfilled the insulin resistance criterion (defined as HOMA-IR > 2.5) compared with those in other study groups. The mean fasting serum asprosin concentration was also significantly higher in the valproic acid group than in other study groups. This was while the values of the study parameters were comparable in the healthy, un-treated, and lamotrigine groups. CONCLUSIONS: Our finding suggested that elevated asprosin level might be one of the pathological mechanisms involved in the development of obesity, insulin resistance, and metabolic disturbances related to valproic acid treatment.

MIF and MMP-9 Serum Changes in Type II Diabetes and Non-Diabetic Subjects: A Short Communication.

BACKGROUND & OBJECTIVE: Diabetes is a metabolic disease and is associated with failure of various organs. Macrophage migration factor (MIF) and matrix metalloproteinase (MMP-9) are two of the most important factors in the pathogenesis of diabetes. METHODS: In this descriptive-analytical study, 30 patients with type 2 diabetes mellitus from Hamadan Diabetes Center were selected by convenience sampling. Moreover, 30 healthy first-degree relatives and 30 unrelated non-diabetics, were examined for MMF and MMP-9 and their variations based on age, gender, body mass index (BMI) and hemoglobin A1C. RESULTS & CONCLUSION: The mean and standard deviation of MIF in diabetic patients, and relatives and non-relatives of diabetic patients were 592.87±78.19, 131.82±88.27 and 94.63±23.88, respectively (P<0.001). The mean and standard deviation of the MMP-9 in diabetic patients, and relatives and non-relatives of diabetic patients were 2570.64±2220.03, 918.57±650.08 and 629.09±288.32, respectively (P<0.001). MIF and MMP-9 did not have a significant relationship with age, sex, duration of disease and BMI. However, we observed a direct and significant correlation between hemoglobin A1C and the level of MIF and MMP-9 (P<0.001). In patients with type 2 diabetes, serum levels of MMP-9 and MIF, consistent with HbA1c, increase with no significant association with age, sex, BMI and duration of diabetes.

Accuracy of Mean Platelet Volume (MPV) and Red Cell Distribution Width (RDW) for the Diagnosis of Acute Appendicitis: Evaluation of Possible New Biomarkers.

INTRODUCTION: Acute appendicitis is the most common cause of the abdominal pain in surgery. Despite its significant prevalence, the diagnosis is associated with many problems in some cases, which leads to false appendectomy. OBJECTIVE: The aim of this study was to determine the validity of diagnostic tests of mean platelet volume (MPV) and red cell distribution width (RDW), as a new possible tool in the diagnosis of acute appendicitis. Methods: In this study, all patients who referred to the emergency department of Besat Hospital, Hamadan, Iran, in 2015, with abdominal pain and first impression of acute appendicitis, undergone appendectomy, were evaluated. The diagnostic markers of pre-operative and post-operative pathology and the validity of MPV and RDW were determined in diagnosis of acute appendicitis. RESULTS: Laboratory and clinical data from 438 patients, presenting the signs and symptoms of acute appendicitis with the mean age of 26.51±13.9 years, were examined (55.6% men). The sensitivity, specificity, positive and negative predictive value of MPV in the diagnosis of acute appendicitis were 59.77, 98.66, 99.5 and 34.26 percent, and for the RDW were 57.79, 56.00, 86.07 and 21.98 percent, respectively. The area under the receiver operating characteristic (ROC) curve for RDW and MPV was 0.61and 0.90, respectively. The mean of MPV in patients with normal pathologic outcome was 9.52±1.60 and in patients with acute appendicitis was 7.51±1.22. There was a significant difference between the mean MPV in both groups (p<0.001). The mean of RDW in patients with normal pathology were 13.42±1.97 and 13.05±1.09, in patients with acute appendicitis. There was a significant difference between the mean RDW of the two groups (p=0.009). CONCLUSION: MPV and RDW indexes have the potential to be used by the surgeons in diagnosis of acute and perforated appendicitis, especially in adults, in order to reduce unnecessary appendectomy, but MPV is more valid in screening acute appendicitis, compared to the RDW.

The diagnostic values of procalcitonin and interleukin 6 in acute appendicitis.

OBJECTIVE: Despite the recent use of computed tomography scan and diagnostic laparoscopy, acute appendicitis is still highly misdiagnosed. Timely diagnosis of acute appendicitis is more crucial in children and elderly patients because of vague symptoms and rapid progression to perforation in these age groups, which may result in high rates of morbidity and mortality. The aim of the present study was to find the diagnostic values of procalcitonin and interleukin 6 (IL-6) for diagnosing acute appendicitis in our center. MATERIAL AND METHODS: Patients who were suspected of acute appendicitis and who were referred to the emergency department of a tertiary care urban hospital in 2016 were enrolled in the study. A 5 mL blood sample was obtained from each patient before appendectomy and was examined for procalcitonin and IL-6. Then, the resected specimen of the appendix was studied by a pathologist, and a definite diagnosis was made. RESULTS: Eighty patients including 53 (66.3%) men who underwent appendectomy were enrolled in the study. The diagnosis of acute appendicitis was histopathologically confirmed in 60 (75%) patients including 18, 20, and 22 patients with inflammatory, suppurative, and gangrenous/perforated appendicitis, respectively. The sensitivity and specificity of procalcitonin versus IL-6 for diagnosing acute appendicitis were 65% and 80% vs. 76% and 55%, respectively. The sensitivity and specificity of concurrent procalcitonin and IL-6 for diagnosing acute appendicitis were 95% and 55%, respectively. CONCLUSION: Our study suggests that parallel measurement of procalcitonin and IL-6 decreases unnecessary negative appendectomies.

Intravitreal Injection of Anti-vascular Endothelial Growth Factor Agents for Ocular Vascular Diseases: Clinical Practice Guideline.

PURPOSE: To provide the clinical recommendations for the administration of intravitreal anti-vascular endothelial growth factor (VEGF) drugs especially bavacizumab for ocular vascular diseases including diabetic macular edema, neovascular age-related macular degeneration, myopic choroidal neovascularization, retinal vein occlusion and central serous chorioretinopathy. METHODS: Twenty clinical questions were developed by the guideline technical committee. Relevant websites and databases were searched to find out the pertinent clinical practice guidelines to answer the questions. The technical committee provided possible answers (scenarios) according to the available evidences for each question. All scenarios along with their levels of evidence and the supported articles were sent to the experts for external review. If the experts did not agree on any of the scenarios for one particular clinical question, the technical committee reviewed all scenarios and their pertinent evidences and made the necessary decision. After that, the experts were asked to score them again. All confirmed scenarios were gathered as the final recommendations. RESULTS: All the experts agreed on at least one of the scenarios. The technical committee extracted the agreed scenario for each clinical question as the final recommendation. Finally, 56 recommendations were developed for the procedure of intravitreal anti-VEGF injection and their applications in the management of ocular vascular diseases. CONCLUSION: The implementation of this guideline can standardize the management of the common ocular vascular diseases by intravitreal injection of anti-VEGF agents. It can lead to better policy-making and evidence-based clinical decision by ophthalmologists and optimal evidence based eye care for patients.

Correlation of serum intercellular adhesion molecule 1 and vascular endothelial growth factor with tumor grading and staging in breast cancer patients.

BACKGROUND: Breast cancer is the most common cancer among women. There are several prognostic factors for this disease. The aim of this article is to explore the correlation of serum level of vascular endothelial growth factor (VEGF) and intercellular adhesion molecule 1 (ICAM1) with tumor, node, metastasis staging and grading of breast cancer. MATERIALS AND METHODS: Serum samples of 51 patients with breast cancer were assessed with enzyme-linked immunosorbent assay for the level of VEGF and ICAM1 preoperatively. After the operation, histopathologic specimens stained with hematoxylin and eosin were evaluated for tumor size, histopathologic subtype, grade, lymph node, vascular and lymphatic involvement. Then, the correlation of tumor stage and grade and serum level of markers was analyzed. RESULTS: There was no significant correlation between serum level of markers with vascular invasions, lymph node involvement, and menstruation. There was a weak correlation between tumor size and serum level of ICAM1 with Pearson score correlation, but there was no significant correlation with VEGF. There was no significant correlation between tumor grading and staging with the level of markers. There was a significant correlation between the level of VEGF and ICAM1 and histologic type of tumors in invasive through in situ tumors. CONCLUSION: Levels of VEGF and ICAM1 can be used as a predictor of tumor invasion and also for target therapy.

Correlation Between Subclinical Hypothyroidism and Dyslipidemia.

BACKGROUND & OBJECTIVE: Thyroid hormones have an important role in the regulation of lipid metabolism. Subclinical hypothyroidism (SCH), defined as a mild increase in thyroid-stimulating hormone (TSH) and normal level of thyroxine (T4), could be associated with altered lipid profile. The current study aimed at assessing the association between SCH and changes in lipid profile. METHODS: Data of 53 patients with SCH and 53 euthyroid cases were collected from Besat Hospital in Hamadan, Iran, in 2013. The age range of the cases was 18 to 60 years, and the groups were matched in terms of gender, age, and body mass index (BMI). SCH was defined as a TSH value of 4.2 to 10 mU/L, and normal T4 as 0.8 to 2.8 ng/dL. Control cases had a normal TSH ranging from 0.5 to 4.2 mU/L. The total serum cholesterol (TCHOL), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride (TG) levels in both groups were examined and the results were recorded. RESULTS: Participants with SCH had significantly higher LDL and lower HDL levels than the control group regardless of age group and gender (P-value <0.001), but there was no difference in TG and TCHOL levels (P-value <0.05). The prevalence of dyslipidemia and SCH was only significant in females (P-value =0.009). Totally, there was significant correlation between the prevalence of dyslipidemia and SCH regardless of gender (P-value =0.04). CONCLUSION: SCH is associated with dyslipidemia, and biochemical screening for thyroid dysfunction is recommended in all patients with dyslipidemia.

Effect of myomectomy on endometrial glutathione peroxidase 3 (GPx3) and glycodelin mRNA expression at the time of the implantation window.

BACKGROUND: In fertile women, glycodelin and glutathione peroxidase 3 (GPx3) genes expression rises during the luteal phase, with a peak occurring during the implantation window. The expression of these genes decreases in women with myomas. To determine whether myomectomy would reverse glycodelin and GPx3 expression, we evaluated the transcript levels of these genes in the endometrium of patients before and after myomectomy. METHODS: Expression of glycodelin and GPx3 genes were examined prospectively during the midluteal phase in the endometrium obtained from infertile women with myoma (n = 12) before and three months after myomectomy. Endometrial expression of these genes was evaluated using quantitative real-time RT-PCR. RESULTS: Endometrial glycodelin mRNA expression levels (normalized to 18S rRNA expression) were increased significantly in endometrium of patients after myomectomy (P = 0.02). GPx3 mRNA expression was increased insignificantly after myomectomy (P = 0.43). CONCLUSION: The results showed that myomectomy increased endometrial glycodelin (significantly) and GPx3 (not significantly) gene expression after 3 months. Study at different times and detecting expression of these genes can reveal more details.

Assessment of the anterior chamber parameters after laser iridotomy in primary angle close suspect using Pentacam and gonioscopy.

AIM: To evaluate the changes in the anterior segment parameters of the subjects with primary angle closure suspect (PACS) before and after laser iridotomy (LI) using the Pentacam and gonioscopy. METHODS: Forty-eight eyes of 48 PACS were included. Anterior chamber angle (ACA), central anterior chamber depth (ACD), anterior chamber volume (ACV) and central corneal thickness (CCT) were recorded from the Pentacam before and one month after LI. ACA was graded according to Shaffer classification using the Goldmann gonioscopy. RESULTS: ACA increased significantly from 25.59±4.41 to 26.46±4.33 degrees (P=0.009) and ACV changed from 85.97±16.07mm(3) to 99.25±15.83mm(3) (P=0.000). The changes in ACD, CCT and intraocular pressure were non-significant (P>0.05). Gonioscopy showed significant widening of the Shaffer angle in 4 quadrants (P<0.001). CONCLUSION: Pentacam can serve as the objective instrument in assessing the efficacy of LI.

Simultaneous multiple branch retinal artery occlusions after diagnostic cardiac catheterization.

PURPOSE: We describe a 53-year-old man with a decrease in visual acuity in the left eye 2 weeks after diagnostic cardiac catheterization. DESIGN: Interventional case report. METHODS: A 53-year-old man with a decrease in visual acuity in the left eye 2 weeks after diagnostic cardiac catheterization underwent ophthalmoscopic, angiographic, and laboratory evaluations. Both funduscopy and fluorescein angiography confirmed the diagnosis of simultaneous multiple branch retinal artery occlusions in the left eye. RESULTS: The left eye had a mildly positive (1+) relative afferent pupillary defect. Slit-lamp biomicroscopy was unremarkable except for 2+ nuclear cataract bilaterally. Intraocular pressure was 12 mmHg in the right eye and 11 mmHg in the left eye by applanation tonometry. Funduscopy revealed a normal right eye. CONCLUSION: This case report of multiple branch retinal artery occlusions due to cholesterol embolus after diagnostic cardiac catheterization is extremely rare. Visual symptoms after cardiac catheterization should alert both ophthalmologists and cardiologists to this potential post-cardiac catheterization complication.