One-year prevalence and the association between SARS-CoV-2 cycle threshold, comorbidity and outcomes in population of Babol, North of Iran (2020-2021).

Background: The present study aimed to investigate the one-year prevalence of SARS-CoV-2, common comorbidities and demographic information among negative- and positive rRT-PCR in health care workers (HCW), hospitalized and outpatients. Also, the association between SARS-CoV-2 cycle threshold (Ct) and the outcomes of patients were analyzed in Babol, northern Iran. Methods: This large retrospective cross-sectional study was performed between March 2020 and March 2021. The records of 19232 hospitalized, outpatients and HCW suspected to COVID-19 were collected from teaching hospitals in the North of Iran. Results: Out of the 19232 suspected to COVID-19 patients, 7251 (37.7%) had a positive rRT-PCR result; 652 (9%), 4599 (63.4%) and 2000 (27.6%) of those were categorized as HCW, hospitalized and outpatients, respectively. Moreover, between the hospitalized and the outpatient group, 10.2 and 0.8% cases died, whereas no death cases were reported in the HCW. Furthermore, it seems that death rate was significantly different between the three groups of Ct value, the highest mortality in those with Ct between 21 and 30 (group B=7.6%) and the lowest in the group with the highest Ct (between 31 and 40 = 5.5%) (p<0.001). Conclusion: In summary, 37.7% of cases were positive for SARS-CoV-2; of which, 63.4, 27.6 and 9% were hospitalized, outpatients and HCW, respectively. With regard to the mortality rate in hospitalized patients and the significant association with Ct under 20 and 30, it seems that the early detection and the initial quantification of SARS-CoV-2 in the first week of the conflict and therapeutic considerations to reduce the relative load can reduce the mortality rate.

A case of cardiac angiosarcoma and pulmonary tuberculosis; diagnostic challenges and review of literature.

BACKGROUND: Patient symptoms and primary investigational methods may be misleading at some points in patient management and can consume a lot of time. Sarcomas are rare malignancies and contribute 1% of all cancers of adult. CASE PRESENTATION: A rare case of primary cardiac angiosarcoma is presented, who was first treated because of lung tuberculosis and then with only slight improvement in symptoms, further investigations were done showing right ventricular enlargement and pericardial effusion. Eventually, after ruling out pulmonary embolism and constrictive pericarditis, investigations lead to the diagnosis of primary cardiac angiosarcoma. The patient went under surgery to remove the tumor but he still had residual mass left, leading to chemotherapy and then radiotherapy. Although the tumor has a poor prognosis, our patient has managed to survive a year by now and is doing good for 6 months after radiotherapy. CONCLUSION: The case describes the importance of having in mind different differential diagnosis in managing patients and the role of multi-modality imaging in guiding diagnosis and treatment.

Is 99m Tc-methylene diphosphonate bone scintigraphy a sensitive method for detecting bone lesions in multiple myeloma?

BACKGROUND: Bone lesion in multiple myeloma (MM) is most commonly presented as a lytic lesion in this disease. Determination of extent of bone lesions in MM is necessary to follow-up the patients. Whole body bone scan with 99m, Tc-methylene diphosphonate (MDP) has a lower sensitivity than other modalities. METHODS: From the patients with MM admitted to Ayatollah Rouhani Hospital of Babol-Iran from 2009 to 2015, who had undergone whole body bone scan during diagnostic process, were entered into the study. Findings of bone scan were compared with MRI. RESULTS: Of the 19 patients, sixteen (84.2%) of them had positive finding in bone scan, fifteen (78.9%) had MRI of the spine. While of the thirteen patients who had positive finding in MRI, seven (53.8%) had more positive finding in thorcolumbosacral MRI than in bone scan. CONCLUSIONS: 99m-Tc MDP bone scan is a sensitive but insufficient method for detecting bone lesions in MM.

Glomerulonephritis as a Type of Kidney Injury in Multiple Myeloma: a Report of 2 Cases.

Renal involvement in multiple myeloma has multiple etiologies. Glomerulonephritis rarely occurs in multiple myeloma and numerous case reports in the literature explain their correlation. We report 2 cases of glomerulonephritis, one membranous glomerulonephritis and the other focal segmental glomerulosclerosis, in which multiple myeloma was confirmed after several months in the first case and synchronous with the second. Glomerulonephritis can be an uncommon, but not rare, cause of proteinuria in multiple myeloma.

Does Serum lipid profile differ in anemia and non-anemic older subjects?

BACKGROUND: There is some evidence that shows the symptoms of anemia are fewere in overweight and obese people, so, the purpose of this research was to study the relationship between anemia and iron deficiency anemia (IDA) with lipid profile status of the elderly. METHODS: This cross-sectional study came from the Amirkola Health and Ageing Project (AHAP). A demographic questionnaire was given to the older people and a blood sample was obtained to assay their lipid indexes (triglyceride, cholesterol, HDL and LDL) and the parameters related to anemia after 12 hours fasting. The data were analyzed by chi-square test, t-test and Pearson correlation using SPSS. A p<0.05 was considered as the significance level of the tests. RESULTS: The average age of the people was 68.95±7.43 years old. In this study, the prevalence of anemia and IDA was 31% and 9%, respectively. The mean concentration of serum triglyceride, cholesterol and LDL in the anemia group and the IDA group was less than the control groups. The amount of HDL in different groups was almost the same, although the difference was statistically significant with respect to variables like age and obesity (P=0.001). CONCLUSION: The study showed that the amount of lipid profile (triglyceride and cholesterol) in the elderly with anemia and IDA was less compared to other people. This result was achieved in some other research studies too, but further research is suggested to find possible mechanisms.

Ability of serum ferritin to diagnose iron deficiency anemia in an elderly cohort.

BACKGROUND: Diagnosis and treatment of iron deficiency anemia in older subjects improves their quality of life. Serum ferritin as a marker of iron stores is an acute phase protein. In older subjects who usually have many concomitant chronic medical conditions, serum ferritin may increase in response to inflammatory processes irrespective of iron stores. This study was performed to determine the diagnostic properties of serum ferritin in the diagnosis of iron deficiency anemia in older subjects. METHODS: This case-control study included all the inhabitants of Amirkola town who participated in the Amirkola Health and Aging Project. Diagnosis of anemia was confirmed based on a hemoglobin level <13g/dL in men and <12g/dL in women and iron deficiency anemia by percent transferrin saturation <15%. A receiver operating characteristic curve was constructed to determine an optimal serum ferritin cutoff value to differentiate patients with and without iron deficiency anemia at the highest sensitivity and specificity. RESULTS: Eighty patients with iron deficiency anemia and 160 cases of anemia without iron deficiency (mean age: 72.9±8 and 71.6±7.6 years, respectively; p-value=0.37) were analyzed. In iron deficiency anemia, the mean serum ferritin was significantly lower (p-value=0.036) compared to patients without iron deficiency anemia. Serum ferritin with a cutoff level of 100ng/mL differentiated patients with and without iron deficiency anemia with a sensitivity of 60% and specificity of 59% and area under the receiver operating characteristic curve of 0.615±0.040 (95% confidence interval: 0.536-0.694; p-value=0.004). CONCLUSION: These findings indicate that in elderly subjects, iron deficiency anemia may develop with higher levels of serum ferritin. Hence, the conventional cutoff of serum ferritin for the diagnosis of iron deficiency anemia in young adults is not appropriate for the elderly population.

Pericardial Graft vs. Host Disease in a Patient with ß-Thalassemia Major.

Bone marrow transplantation (BMT) in young children improves results in ß-thalassemia major. Graft versus host disease (GVHD) is an important complication of peripheral blood stem cell transplantation. GVHD affects heart with a behavior resembling an autoimmune disease, including pericardial effusion. We describe a 22-year-old ß-thalassemia major patient who underwent bone marrow transplantation with an HLA-identical sibling donor. The patient didn't have any serious problem until 15 months after transplantation. He presented with chest discomfort and progressive dyspnea. Early echocardiogram showed mild pericardial effusion. Four days later, the effusion had increased, impending to cardiac temponade requiring pericardectomy. Immunospressive drugs and pericardectomy resulted in significant improvement in ventricular filling.  Cardiac cGVHD, an un-common complication of HSCT may be presented as pericardial effusion. Although early initiation of steroids is very important, heart monitoring is necessary to diagnose cardiac temponade.

A Case of Multiple Myeloma Following Bladder Cancer.

Second primary malignancy following multiple myeloma (MM) was reported several years ago. There are also rare reports of cases with synchronous MM and other malignancies. To our knowledge, only one case of MM following bladder cancer has been reported in the literature. Here, we report the second case occurred three months after diagnosis of bladder cancer.

Chronic myeloid leukemia following colon cancer treatment: A case report and literature review.

BACKGROUND: Solid tumors may occur in 3% of the patients with chronic myeloid leukemia (CML). In this paper, we presented a case of CML following treatment of colon cancer. CASE PRESENTATION: A 25 year old man was diagnosed of adenocarcinoma of rectosigmoid treated with fluorouracil-based chemotherapy. Following relapse, he received florouracil, oxaliplatin and irinotecan during the next year. Then he developed BCR-ABL positive CML. With Imatinib 400 mg/day, he achieved hematologic response but died because of progressive colon cancer. CONCLUSION: This article emphasizes that there is a possibility for etiologic correlation between CML and chemotherapeutic agents in solid cancers.

Ability of serum ferritin to diagnose iron deficiency anemia in an elderly cohort

Abstract Background Diagnosis and treatment of iron deficiency anemia in older subjects improves their quality of life. Serum ferritin as a marker of iron stores is an acute phase protein. In older subjects who usually have many concomitant chronic medical conditions, serum ferritin may increase in response to inflammatory processes irrespective of iron stores. This study was performed to determine the diagnostic properties of serum ferritin in the diagnosis of iron deficiency anemia in older subjects. Methods This case-control study included all the inhabitants of Amirkola town who participated in the Amirkola Health and Aging Project. Diagnosis of anemia was confirmed based on a hemoglobin level <13 g/dL in men and <12 g/dL in women and iron deficiency anemia by percent transferrin saturation <15%. A receiver operating characteristic curve was constructed to determine an optimal serum ferritin cutoff value to differentiate patients with and without iron deficiency anemia at the highest sensitivity and specificity. Results Eighty patients with iron deficiency anemia and 160 cases of anemia without iron deficiency (mean age: 72.9 ± 8 and 71.6 ± 7.6 years, respectively; p-value = 0.37) were analyzed. In iron deficiency anemia, the mean serum ferritin was significantly lower (p-value = 0.036) compared to patients without iron deficiency anemia. Serum ferritin with a cutoff level of 100 ng/mL differentiated patients with and without iron deficiency anemia with a sensitivity of 60% and specificity of 59% and area under the receiver operating characteristic curve of 0.615 ± 0.040 (95% confidence interval: 0.536-0.694; p-value = 0.004). Conclusion These findings indicate that in elderly subjects, iron deficiency anemia may develop with higher levels of serum ferritin. Hence, the conventional cutoff of serum ferritin for the diagnosis of iron deficiency anemia in young adults is not appropriate for the elderly population.