Microvascular Changes Are Associated with Proteinuria and EMG Changes in Patients with Type 2 Diabetes Using Video Capillaroscopy.

Objectives: Video capillaroscopy is a diagnostic method for evaluating microvascular changes in type 2 diabetes mellitus (T2DM). This study evaluated microvascular changes, including microvascular architecture, capillary distribution (morphology and density), and angiogenesis conditions in T2DM patients via video capillaroscopy. Methods: A total of 256 patients with T2DM enrolled in this study. Based on electromyography (EMG)-nerve conduction velocity results, patients were divided into patients with normal and abnormal EMG. Microalbuminuria was assessed using biochemical urine analysis. Finally, video capillaroscopy was performed to evaluate changes in microvascular architecture, capillary distribution, and angiogenesis status. Results: The differences between microalbuminuria in patients with normal and abnormal EMG were not significant. Other microvascular changes were not significant between normal and abnormal EMG groups. The patients with greater microalbuminuria were at risk of abnormal EMG 2.8 times higher than those with fewer microalbuminuria (odds ratio = 2.804; 1.034-7.601). However, EMG is not a risk factor for microvascular architecture alternation in T2DM (odds ratio = 1.069; 0.323-3.546). Conclusions: Microvascular alternations are common in T2DM and early detection of these changes could help to avoid the progress of nephropathic complications. Also, video capillaroscopy provides a promising diagnostic method for the detection of microvascular alternations in T2DM.

Aneurysmal dilation of sinus of Valsalva in a patient with undiagnosed acromegaly.

Key Clinical Message: In patients presenting with aortic ectasia and myxomatous valve diseases at young ages, possible underlying acromegaly should be in mind. Abstract: Acromegaly is a chronic systemic disease mainly caused by the benign pituitary adenoma secreting growth hormone (GH) in excess. Acromegaly is associated with various complications such as cardiovascular diseases. In this regard, timely diagnosis, and management of these patients could be life-saving. Herein, a case of aneurysmal dilation of the sinus of Valsalva with severe aortic and mitral regurgitation in a patient with undiagnosed acromegaly is presented.

The roles of Eph receptors, neuropilin-1, P2X7, and CD147 in COVID-19-associated neurodegenerative diseases: inflammasome and JaK inhibitors as potential promising therapies.

The novel coronavirus disease 2019 (COVID-19) pandemic has spread worldwide, and finding a safe therapeutic strategy and effective vaccine is critical to overcoming severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Therefore, elucidation of pathogenesis mechanisms, especially entry routes of SARS-CoV-2 may help propose antiviral drugs and novel vaccines. Several receptors have been demonstrated for the interaction of spike (S) protein of SARS-CoV-2 with host cells, including angiotensin-converting enzyme (ACE2), ephrin ligands and Eph receptors, neuropilin 1 (NRP-1), P2X7, and CD147. The expression of these entry receptors in the central nervous system (CNS) may make the CNS prone to SARS-CoV-2 invasion, leading to neurodegenerative diseases. The present review provides potential pathological mechanisms of SARS-CoV-2 infection in the CNS, including entry receptors and cytokines involved in neuroinflammatory conditions. Moreover, it explains several neurodegenerative disorders associated with COVID-19. Finally, we suggest inflammasome and JaK inhibitors as potential therapeutic strategies for neurodegenerative diseases.

Results of surgical and nonsurgical treatment of aneurysms in a developing country.

Background. The impact of invasive methods of treatment on results in developing countries may differ from that in developed countries. Methods. This is a prospective clinical study of consecutive patients with Subarachnoid Haemorrhage (SAH) admitted to the Ghaem Hospital, Mashhad during the period from 2005 to 2009. The initial diagnosis and investigations were carried out by neurologists. The patients were divided into two groups. One received surgical treatment whilst the other group was managed medically. The decision as to the choice of the method of treatment was made by the neurosurgeons. The initial medical treatment was standardised for all the patients. The rate of complications and mortality was compared in both medical and surgical groups. Results. 120 SAH patients (52% females) with a mean age of 50.6 ± 7 years were evaluated. The angiography revealed the presence of an aneurysm in 62 patients. 63.5% of the patients received medical treatment and 37.5% underwent aneurysmal surgery. Difference of rebleeding rate in the two therapeutic groups was not significant; X(2) = .014, P = .91. The effect of rebleeding on mortality was not significant; X(2) = 2.54, P = .14. Within 62 SAH patients with cerebral aneurysm, the mortality rate in both therapeutic groups was also not significantly different; X(2) = .16, P = .77. Conclusion. There is no significant difference in the mortality rate between the "surgical" and non-"surgical" groups of Iranian patients with SAH. This could be due to delay in performance of surgery in Iranian neurovascular centers.

Results of surgical and non-surgical treatment of aneurysms in iran.

BACKGROUND: Direct surgery or endovascular procedures are an accepted way of treating patients with Aneurismal Subarachnoid Haemorrhage (SAH). However the impact of invasive methods of treatment on results in developing countries may differ from that in developed countries. METHODS: This is a prospective clinical study of consecutive patients with Subarachnoid Haemorrhage (SAH) admitted in Ghaem hospital in Mashhad during 2005-2010. The initial diagnosis and investigations were carried out by neurologists. The patients were divided into two groups. One received surgical treatment whilst the other group was managed medically. The decision as to the choice of method of treatment was made by the neurosurgeons. The initial medical treatment was standardised for all the patients. The rate of complications and mortality was compared in both medical and surgical groups. RESULTS: 20 SAH patients (52% females) with a mean age of 50.6±7 years were evaluated. The angiography revealed the presence of an aneurysm in 62 patients. 63.5% of patients received medical treatment and 37.5% underwent aneurysmal surgery. Difference of rebleeding rate in two therapeutic groups was not significant; χ(2)=0.014, P=0.91. The effect of rebleeding on mortality was not significant; χ(2)=2.54, P=0.14. Within 62 SAH patients with cerebral aneurysm, the mortality rate in both therapeutic groups was also not significantly different; χ(2)=0.16, P=0.77. CONCLUSION: There is no significant difference in the mortality rate between the "surgical" and non "surgical" groups of patients with SAH. This could be due to delay in performance of surgery in neurovascular centers in Iran.