The evaluation of the MMP-2/TIMP-1 ratio in peptic ulcer and its association with refractory helicobacter pylori infection.

BACKGROUND: Helicobacter pylori (H. pylori) is one of the leading causes of peptic ulcers, and its treatment is a worldwide challenge. Matrix metalloproteinases and their inhibitors influence the development and healing of peptic ulcers. This study aimed to evaluate the ratios of matrix metalloproteinase-2 (MMP-2) to tissue inhibitor of metalloproteinase-1 (TIMP-1) in patients with peptic ulcers that are sensitive or resistant to H. pylori treatment and compare them with healthy individuals. METHODS: In this study, 95 patients were included and divided into two groups sensitive (41 patients) and resistant to treatment (54 patients). The results were compared with a control group of 20 participants with normal endoscopy and H. pylori-negative. After obtaining written informed consent, five ml of venous blood was taken to determine their serum MMP-2 and TIMP-1 levels using an enzyme-linked immunosorbent assay. RESULTS: In patients with H. pylori-induced peptic ulcers, the MMP-2/TIMP-1 ratio was significantly higher than the healthy controls (P < 0.05). MMP-2 level was associated with patients' response to treatment (P < 0.05). The MMP-2/TIMP-1 ratio was higher in patients with simultaneous gastric and duodenal ulcers (P < 0.05). CONCLUSION: It seems that peptic ulcer disease caused by infection with H. pylori increases the MMP-2/TIMP-1 ratio in patients with peptic ulcers. However, it might not be a good predictor of refractory H. pylori-induced peptic ulcer disease.

Alveolar Microlithiasis with Mild Clinical Symptoms But Severe Imaging Findings: A Case Report.

Pulmonary alveolar microlithiasis (PAM) is a rare genetic disorder that causes calcium phosphate microliths to form in the alveoli. Symptoms usually appear in a person's third or fourth decade of life. A definitive diagnosis does not always demand a lung biopsy but can be achieved in families with more than one member with PAM and compatible chest imaging. We present the case of a 47-year-old woman referred to us for shortness of breath. Chest imaging revealed bilateral diffuse ground-glass opacities, interlobar fissure calcification, and subpleural linear calcifications, leading to a diagnosis of PAM. Although there is no specific treatment for this condition, early diagnosis can help prevent it from progressing rapidly by avoiding exposure to risk factors.

Negative pressure pulmonary edema following laryngospasm after dental abscess: A case report.

Negative pressure pulmonary edema (NPPE), also known as post-obstructive pulmonary edema, is a rare and life-threatening condition. It occurs when a person breathes against an obstructed glottis, causing negative thoracic pressure in the lungs. This negative pressure can lead to fluid accumulation in the lungs, resulting in pulmonary edema. The obstructed glottis might be caused by laryngospasm, which occurs when the muscles around the larynx involuntarily spasm and can lead to complete upper airway occlusion. This report shares the case of a 33-year-old woman hospitalized for periapical dental abscess, facial swelling, and shortness of breath. The patient exhibited signs of poor oral hygiene. After the exacerbation of her symptoms, she showed signs of asphyxia and decreased oxygen saturation, which led to her intubation. Imaging revealed bilateral pleural effusion and patchy ground glass opacities favoring NPPE. After three days of treatment with diuretics and other conservative measures, her condition was alleviated, and she was extubated. Laryngospasm in the presence of a dental abscess is uncommon. Identification of imaging favoring NPPE in this setting is even more rare. In cases of laryngospasm, prompt intubation is crucial. Therapy with diuretics and other conservative measures can effectively treat NPPE following laryngospasm.

Pulmonary apoplexy following severe mitral valve stenosis: A case report.

Hemoptysis is a common clinical symptom in emergency patients. It is characterized by the discharge of bloody sputum, which originates from the lower respiratory tract. In the majority of cases, this event is self-limiting, and only in less than 5% of cases, it is massive. Mitral valve stenosis is an uncommon cause of hemoptysis, with a prevalence of 4.2%. In rare cases of this condition, massive and sudden hemoptysis occurs, which is called pulmonary apoplexy. Here, a 35-year-old woman with a history of mitral valve stenosis is introduced who was referred to the hospital with a complaint of massive hemoptysis and sudden shortness of breath. According to the history of mitral valve stenosis, the patient was diagnosed with pulmonary apoplexy. After treatment, both the imaging findings and the patient's symptoms resolved within a short period of time. Even though pulmonary apoplexy is often severe, it can still respond well to conservative treatments and may indicate a need for immediate attention to the stenosis of the mitral valve.

A case of a Young Multiple Myeloma Patient With Poor Prognostic Cytogenetics.

Multiple myeloma is a hematologic malignancy and a subtype of plasma cell dyscrasias, which accounts for 13% of all hematologic malignancies. It mainly affects older adults and is diagnosed in only 2% of the young population under the age of 40 years. This report presents a 33-year-old man diagnosed with Multiple myeloma with 4 poor prognostic specifications consisting of amplification of the 1q21, Translocation of t(4;14), deletion of the 6q21 and 13q14, along with decreased chromosome count to 44, X,-Y. Even though the combination of 4 poor prognostic cytogenetics in young patients is rare, he responded significantly to the Bortezomib regimen. He was selected as a candidate for bone marrow transplantation. The treatments get interrupted 2 days after the first session of the fifth cycle due to an undesirable COVID-19 infection. After 20 days, the symptoms return, and paraclinical findings show signs of MM relapse.

Aggressive systemic mastocytosis with multiple organ involvement: a case report.

Systemic mastocytosis is a rare malignancy whose main diagnostic finding is the abnormal proliferation of clonal mast cells. In this report, a 63-year-old woman is presented who was referred to the emergency department with lower back pain. Due to the hypereosinophilia in blood tests, a bone marrow biopsy was performed, and except for the presence of a large number of mastocytes, no other pathologic findings were seen. Furthermore, the immunohistochemistry test showed positive CD117 and CD25 markers, and the patient's platelet-derived growth factor receptor alpha test was positive. Hence, the patient was diagnosed with aggressive systemic mastocytosis. Treatment was initiated with the Cladribine regimen, but unfortunately, in the third course, the patient experienced bradycardia and loss of consciousness and expired. Systemic mastocytosis can manifest itself with non-cutaneous symptoms. Non-cutaneous symptoms do not rule out systemic mastocytosis as a differential diagnosis in patients with hypereosinophilia.

A Case of Acute Respiratory Distress Syndrome Following Pleurodesis With Talc.

Management of malignant pleural effusion is a medical challenge, and several methods have been proposed to deal with it including thoracentesis, indwelling pleural catheter placement, and chemical or mechanical pleurodesis. Each method, however, has its advantages and disadvantages. Talc pleurodesis is generally recognized as the most effective and safest method for the induction of chemical pleurodesis. However, in rare cases, it can lead to acute respiratory distress syndrome (ARDS). In this article, we report the case of a patient with metastatic adenocarcinoma to the pleura who presents with shortness of breath and malignant pleural effusion, develops ARDS after pleurodesis with talc, and expires despite the partial improvement of lung involvement. The symptoms and causes of this rare side effect as well as the methods that can be used to deal with it are reviewed in this article.

Extramedullary hematopoiesis in ribs and severe pulmonary hypertension disease following intermediate beta-thalassemia: a case report.

BACKGROUND: Thalassemia is a type of congenital hemoglobinopathy that falls into the category of hemolytic anemias. Extramedullary hematopoiesis is a complication of this disease, which is a mechanism to compensate for chronic anemia in these patients, and imaging is the best diagnostic method. CASE REPORT: In this report, a 36-year-old Caucasian female patient with intermediate beta thalassemia is presented who, at the time of referral, complained of exacerbated shortness of breath. Imaging showed diffuse expansion masses with soft tissue components in the ribs of both hemithoraxes, leading to the diagnosis of extramedullary hematopoiesis. CONCLUSION: Extramedullary hematopoiesis in the ribs is an uncommon finding in patients with thalassemia and is a sign of the severity of the disease and a poor prognostic factor that might be preventable if blood transfusion begins at younger ages.

A case of Hermansky-Pudlak with dyspnea.

Hermansky-Pudlak syndrome (HPS) is a rare multisystem disorder inherited in an autosomal recessive manner. Its prevalence is 1 in 500 000 to 1 000 000 people worldwide. The cause of this disorder is genetic mutations that lead to defective organelles of lysosomes. In this report, a 49-year-old man is introduced who was referred to the medical center with ocular albinism and recently exacerbated shortness of breath. Imaging showed peripheral reticular opacities, ground-glass opacities of the lungs with subpleural sparing in some regions, and thickening of bronchovascular bundles, which were all in favor of non-specific interstitial pneumonia. This imaging pattern is an unusual finding in a patient with HPS.

Amiodarone-induced blue man syndrome: a case report.

BACKGROUND: Amiodarone is one of the most commonly used and effective antiarrhythmic drugs to treat ventricular and supraventricular arrhythmias. Besides its advantages, this drug has side effects like liver, digestive, pulmonary, thyroid, neural, skin, optical, hematologic, psychiatric, and cardiac complications. Blue-gray cutaneous discoloration, also known as blue man syndrome, is an undesirable and unusual side-effect of chronic amiodarone therapy in less than 3% of patients. CASE PRESENTATION: This report presents a 51-year-old Caucasian man treated for the past 3 years with amiodarone and implantable cardioverter defibrillators due to his ventricular arrhythmia and cardiomyopathy, without any follow-up visit to his doctor. He was referred to the medical center for blue-gray discoloration on his nose and cheeks, which had started to appear in the last 3 weeks. CONCLUSION: Considering the findings obtained in this report and the numerous side effects of amiodarone, the blue-man syndrome is a rare yet important finding of this drug which may influence the patient's daily life. It is recommended that all patients under treatment with this drug be notified about its side effects and visit their doctors regularly. Regarding the high therapeutic value of this drug, the lack of any association between blue man syndrome and other complications, and the related aesthetic problems, the role of the caregiver becomes much more critical in the prescription of amiodarone.

Sudden development of the upper and lower limb ischemia as the first manifestation of COVID-19 infection.

Introduction and importance: Atherosclerosis is the most common cause of peripheral vascular disease, and common predisposing causes are inflammation and diabetes. It is over two year that the COVID-19 pandemic has impacted the world and costed millions of lives. Case presentation: The patient was a case of COVID-19 infection presenting as acute arterial occlusion in the upper and lower limb. Clinical discussion: Hyper coagulopathy is one of the COVID-19 outcomes that may develop PAD following the involvement of vascular endothelium in the cytokine storm phase. Endothelial damage following COVID-19, especially in those with underlying diseases such as diabetes mellitus or inflammatory diseases with vascular involvement, can cause acute vascular events. Conclusion: Patients with inflammatory diseases and diabetes are prone to the uncommon symptoms of COVID-19 and more vulnerable to peripheral vascular occlusion, especially when the underlying disease remains uncontrolled, so anticoagulation with therapeutic doses is recommended for their treatment. Inflammation as a predisposing factor for PAD should be controlled using plasmapheresis or anti-inflammatory drugs depending on the patient's condition.

A case of recurrent pneumothorax and skin lesions diagnosed with Birt-Hogg-Dubé.

Birt-Hogg-Dubé (BHD) syndrome is an autosomal dominant disease that is manifested as benign cutaneous tumors, multiple lung parenchymal cysts and an increased risk of renal cancer. Its symptoms usually do not appear until adulthood. We report a patient who was admitted with recurrent pneumothorax. Discovering typical cutaneous lesions accompanied with a history of the same condition in his son, BHD syndrome was diagnosed.

Renal vein thrombosis after COVID-19: A case report.

Severe cases of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-Coronavirus-2, can lead to pneumonia or acute respiratory distress syndrome. Non-respiratory manifestations of COVID-19 include venous and arterial thrombosis. The disease can affect all organs and even the kidneys and lead to renal vein thrombosis where renal veins or their branches become thrombotic leading to symptoms such as flank pain, hematuria, or acute kidney damage. In this study, a case of renal vein thrombosis after COVID-19 is introduced and the causes and complications of this disease are analyzed.

Hematological Parameters as Diagnostic Factors: Correlation with Severity of COVID-19.

Bachground and aim: Coronavirus disease 2019(COVID-19), which is the pandemic of 21st century, is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Prognostic factors play an essential role in predicting the patients who need more care. Therefore, the current study aimed to investigate the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) ratio as discriminated indexes in prognosis of patients with COVID-19. METHODS: Age, NLR, PLR, white blood cell (WBC), neutrophil count, lymphocyte count and platelet from 1007 hospitalized patients with COVID-19, who were admitted to two referring hospitals  in Ardabil, North Western Iran. All confirmed cases divided into non-severe and severe groups. RESULTS: 534 (53.4%) males and 473 (47.3 %) females with mean age of 52 years were enrolled in this study. Patients with severe COVID-19 have lower counts of lymphocyte, but have higher NLR, comparing to non-severe patients (P = 0.001). CONCLUSION: Elevated NLR can be assumed as an independent biomarker, which could provide a crucial indicator in the monitoring patients with COVID-19 on admission. Increased NLR was correlated with the severity of COVID-19. Assessment of NLR could be proposed to identify high risk individuals with COVID-19.

The effect of convalescent plasma on the treatment of COVID-19 patients in Ardabil, Iran.

BACKGROUND: Infection with COVID-19 has resulted in considerable mortality all around the world. This study aimed to investigate the effect of convalescent plasma on the treatment of hospitalized patients with COVID-19 in Imam Khomeini Hospital at Ardabil, Iran. MATERIALS AND METHODS: In this quasi-experimental clinical trial, patients over 18 years of age with polymerase chain reaction-positive COVID-19 were admitted based on the clinical criteria of respiratory distress with hypoxia (O2 saturation <90) and tachypnea (R Relative Risk (RR) >24) with moderate-to-severe lung involvement and in the 1st week of respiratory disease who were not intubated were nonrandomly assigned to two groups: convalescent plasma therapy (CPT) group (197 cases) and control group (200 cases). We used the Chi-square, t-test, Fisher's exact test, and Pearson's correlation coefficient for statistical analysis. RESULTS: Analyses revealed that length of stay in hospital was significantly lower in the CPT group as compared to the control group (P = 0.001). Twenty-four cases (22.0%) in the CPT group and 85 cases (78.0%) in the control group needed intubation. Furthermore, mortality was 17 cases (18.3%) in the CPT group and 76 cases (81.7%) in the control group, the difference of which was also found to be statistically significant (P < 0.05). CONCLUSIONS: It seems that CPT can be used as an alternative treatment at the early stages of COVID-19 to prevent the progress of the disease, reduce the need for intubation and consequently the length of stay in hospital, and finally, decrease mortality.

Mortality Rate of Sepsis Patients in the Intensive Care Unit: The Prognostic Role of Ejection Fraction and Procalcitonin.

Sepsis is the second leading cause of death in the intensive care unit (ICU) and is one of the important causes of death for all hospitalized patients [1]. Evidence revealed procalcitonin as the critical risk factor for determining the prognosis of septic patients [2,3].Also, new studies indicated that diastolic dysfunction and low ejection fraction (EF) were identified as risk factors for death in septic patients [4]. Indeed, septic patients with lower EF had higher mortality rates than other septic patients [5]. Hence, in the pilot study, we determine the mortality rate of hospitalized patients in our clinic during 2020. Besides, EF was evaluated via echocardiography, and also serum PCT was measured on the first day of admission to ICU. Our results indicate that 35 % and 65 % of patients were expired and discharged, respectively. The association between EF and mortality is shown in Figure-1. There were no significant differences between EF and mortally among studied patients (P=0.79). The mean PCT in expired patients was 7.67 ±5.52 ng/ml, while in the discharged patients was 4.21±3.1 ng/ml. On the other hand, although the mean PCT level in the expired patients was higher than those discharged, this difference was not significant. Our study revealed that although PCT and EF statistically were not different in expired patients compared to those discharged, both PCT and EF could be considered important prognostic factors for mortality among sepsis patients in the ICU. However, more studies with larger sample sizes and more parameters for the determination of EF and PCT are recommended.

Implanting jejunostomy tube as conservative management of tracheoesophageal fistula in a COVID-19 patient.

A 44-year-old woman with Behcet's disease experienced a severe COVID-19 infection and developed a tracheoesophageal fistula. Despite the need for surgical treatment, she did not consent. Therefore, the patient underwent supportive treatment with a jejunostomy tube. After four weeks of follow-up, the fistula was repaired spontaneously.