The long-term impact of bariatric surgery on psoriasis symptoms and severity: a prospective observational study.

BACKGROUND: Psoriasis is a common immune-mediated inflammatory skin disease associated with various comorbidities, including obesity. OBJECTIVE: This study aimed to investigate changes to psoriasis symptoms, severity, and treatment agents in patients undergoing Metabolic and Bariatric Surgery (MBS). SETTING: Rasool-E Akram University Hospital. METHODS: This prospective observational study consisted of 32 adult patients with obesity and psoriasis who underwent MBS (e.g., Roux-en-Y gastric bypass, One anastomosis gastric bypass, sleeve gastrectomy) between January 2010 and December 2020. Patients with a history of prior MBS were excluded. All patients were examined by a board-certified dermatologist. Psoriasis severity was assessed with the Psoriasis Area and Severity Index (PASI). RESULTS: The majority of patients were females (n = 29). The mean age of the study population was 46.6 ± 10.8 years, and participants were followed-up for 70.6 ± 29.1 months. A significant decrease in BMI was observed postoperatively from 41.5 ± 4.7 to 30 ± 5.5 kg/m2 (P < .001). PASI score significantly decreased from a median (interquartile range [IQR]) of 3.6 (5.90) to 1.20 (3.45) after MBS (P = .006). The number of patients who reported nail involvement significantly decreased following surgery (P = .039), although no significant difference in joint involvement was noted (P = 1.000). CONCLUSION: This study shows that MBS can reduce psoriasis severity and lower the number of needed treatments. Given psoriasis's complexity and varied individual responses, personalized treatment is essential. Further research is necessary to validate these findings in a larger population.

Upper gastrointestinal obstruction as an unusual presentation of thoracoabdominal huge aortic aneurysm; a case report.

INTRODUCTION AND IMPORTANCE: Giant aortic aneurysms, defined as those exceeding 10 cm in diameter, present considerable risk to life if not addressed. Thoracoabdominal aortic aneurysms (TAAAs) are particularly perilous due to their propensity for rupture. CASE PRESENTATION: We report a case of gastrointestinal obstruction manifesting from a giant thoracoabdominal aortic aneurysm with a contained leak and acute rupture. The patient presented with abdominal pain, nausea, vomiting, and intolerance to oral intake. CLINICAL DISCUSSION: Certain conditions and infections predispose individuals to the development and expansion of giant aneurysms. This report details a massive chronic TAAA with a confined leak that led to a circumferential mural thrombus and an acute rupture within it. The patient was resuscitated and underwent urgent aorto-renal reconstruction surgery due to the presentation of upper gastrointestinal obstruction. CONCLUSION: Though upper gastrointestinal obstruction is an extremely rare manifestation of giant thoracoabdominal aneurysm, it should be considered as a differential diagnosis in similar cases.

Reconstruction of nasal and upper lip defect using bilateral inferiorly based malar transposition flaps: A case report.

INTRODUCTION AND IMPORTANCE: Surgical flaps are accepted as the best option for nasal reconstructions depending on various factors, including defect etiology, size, location, and depth. CASE PRESENTATION: A 71-year-old man presented with a squamous cell carcinoma of the columella extended to the nasal tip and upper lip. He underwent Mohs resection followed by staged reconstruction with bilateral inferiorly-based malar transposition flaps. Then, the patient was scheduled for radiation therapy for fourweeks. The patient had been free of recurrence after a two-year follow-up. CLINICAL DISCUSSION: In this case, the inclusion of the upper lip and columella defect restricted our choices. However, the bilateral malar transposition flap effectively covered both nasal and upper lip defects, providing an excellent tissue match without the need for a skin graft. This method is particularly suited for extensive multiple nasal subunits and upper lip defects. CONCLUSION: A malar transposition flap may be an adequate alternative for columella and upper lip reconstruction after skin cancer resection.

Cardiac metastasis from gastric adenocarcinoma: A rare case report.

INTRODUCTION AND SIGNIFICANCE: Cardiac dissemination of gastric adenocarcinoma represents an exceedingly uncommon clinical scenario. To date, there is an absence of documentation concerning the presence of tumor emboli within the cardiac chambers originating from gastric cancer, particularly following a possible transvenous migration. CASE PRESENTATION: This report delineates the clinical journey of a 60-year-old female diagnosed with inoperable diffuse gastric adenocarcinoma, who developed cardiac metastases. CLINICAL DISCUSSION: The prognostication of isolated cardiac metastasis in oncology patients is fraught with difficulty due to its infrequency and non-specific clinical manifestations. While systematic screening for cardiac metastasis is not part of standard oncological protocols, heightened vigilance is warranted in specific scenarios such as advanced-stage malignancies or in the presence of suggestive cardiac symptomatology, thereby prompting further exploration. CONCLUSION: Cardiac metastasis, while infrequent, constitutes a dire clinical entity that must be contemplated in the differential diagnosis of cardiac mass presentations in individuals with a neoplastic history. Prompt recognition and deployment of appropriate diagnostic imaging are pivotal for informed therapeutic decision-making. An integrative, multidisciplinary strategy is imperative for the formulation of an optimal treatment paradigm, encompassing surgical and palliative care options. KEY CLINICAL MESSAGE: Cardiac metastasis of gastric adenocarcinoma are extremely rare, however, in gastric cancer cases with cardiopulmonary manifestation should be considered as a probable differential diagnoses.

Neck schwannoma with phrenic nerve involvement: A rare case report.

INTRODUCTION AND IMPORTANCE: Phrenic nerve schwannoma is an occasional axonal tumor that is mostly asymptomatic. CASE PRESENTATION: In this report, a man with a painless lump in his neck was the subject. His diagnostic process included the recording of schwannoma. Phrenic schwannoma was removed by surgery without any complication during follow-up. CLINICAL DISCUSSION: Surgical excision under general anesthesia was done for the patient and during the surgical explore, the surgeon observed that, the schwannoma arose from the cervical phrenic nerve. The cervical mass was dissected from the phrenic nerve precisely by intracapsular enucleation technique. CONCLUSION: The phrenic involvements of schwannomas are extremely rare and mostly presented as a painless mass. Additionally, complete surgical excision of them is an efficient method.

A narrative review on adverse drug reactions of COVID-19 treatments on the kidney.

Studies showed that the respiratory is not the only system affected by coronavirus 2, while cardiovascular, digestive, and nervous systems, as well as essential organs such as the kidneys, can be affected by this virus. In this review, we have studied the epidemiology, clinical, and laboratory findings on COVID-19 infection renal involvement, mortality, physiopathology, remaining renal sequels after recovery, underlying renal disease, and renal injury due to its treatment. Also, protective measures for kidney injury are explained in three levels. Evidence of viral particles and genome in the urine and renal tubular cells and signs of damage such as microangiopathy, hypercoagulopathy, and fibrosis are found in COVID-19 patients. The result of this study showed, in hospitalized COVID-19 patients, that the rate of acute kidney injury (AKI) was up to 46%, with a mortality ranging from 11 to 96%. A considerable proportion of patients with AKI would remain on renal replacement therapy. Proteinuria and hematuria are observed in 87 and 75% patients, and increased Cr and glomerular filtration rate (GFR) <60 ml/min per 1.73 m2 are observed in 29.6 and 35.3% of the patients, respectively. Remedsivir is considered to have adverse effects on GFR. COVID-19 patients need special attention to prevent AKI. Those with underlying chronic kidney disease or AKI need proper and explicit evaluation and treatment to improve their prognosis and decrease mortality, which should not be limited to the hospitalization period.

Primary aortoduodenal fistula: As a first presentation of brucellosis; a case report.

INTRODUCTION: The etiologies of primary aortoenteric fistula include aneurysm (most common), foreign body, tumor, radiation therapy, and infection (e.g., tuberculosis, syphilis). Brucellosis is a rare cause of primary aortoenteric fistula. PRESENTATION OF CASE: In this study, we reported the case ofa 55-years-old male with an aortoenteric fistula and a positive brucellosis test. DISCUSSION: In regions where brucellosis is endemic, the coexistence of aortitis and aneurysm should prompt consideration of brucella infection as a relatively uncommon cause of aortoenteric fistula. CONCLUSION: While aortitis due to brucellosis is rare, it can lead to life-threatening manifestations such as aortoduodenal fistula. Therefore, we recommend the use of Wright, Coombs Wright, and 2ME tests in similar cases.

Sudden sensorineural hearing loss after receiving an inactivated viral vaccine, Sinopharm: Two-case report.

The prevalence of Coronavirus Disease 2019 is a global threat. Due to the high mortality rate caused by this disease, the vaccination is mandatory to protect patients against it and reduce the mortality. Rapid development and widespread use of vaccines have raised the possibility of adverse side effects over the course of administration and follow-up. In this study, we investigated an adverse event of sudden sensorineural hearing loss in two patients receiving first dose of Sinopharm, an inactivated viral vaccine. Both patients experienced sudden hearing loss in their left ear some days after receiving the first dose of the Sinopharm and had normal otoscopic examinations in both ears and mild to severe sensorineural hearing loss was reported in the left ear. After imaging evaluation with magnetic resonance imaging which showed no pathologic points. Two patients were treated with prednisolone and valacyclovir. Both patients experienced response and had good prognosis in their follow-up. Our study showed that there is no direct evidence of an association between Coronavirus Disease 2019 vaccination. A viral infection can cause sudden sensorineural hearing loss and should be considered as a possible side effect after vaccination. Although the number of side effects reported in clinical trials has been very low, long-term follow-up of patients is needed to assess the vaccine's safety, given the incidence of these cases.

Trunnionosis in metal-on-polyethylene total hip arthroplasties: Report two cases.

INTRODUCTION AND IMPORTANCE: Several studies have discussed trunnionosis in metal-on-metal total hip arthroplasties. However, trunnionosis in metal-on-polyethylene total hip arthroplasties has been less frequently discussed. CASE PRESENTATION: In this study, trunnionosis in two male patients undergoing metal-on-polyethylene total hip arthroplasty, which was done to treat femoral head osteonecrosis were reported and discussed adequately. CLINICAL DISCUSSION: Total hip arthroplasties (THA) were done for the treatment of femoral head osteonecrosis in these cases. In the first case, trunnionosis occurred one year after the revision of the primary THA, and in the second case occurred ten years after the primary THA. Both of these cases were presented with reduced range of motion. After surgery, the symptoms were resolved, and the patients remained complication-free until the last follow-up. CONCLUSION: This report raises awareness regarding the importance of trunnionosis as a serious complication of modular total hip arthroplasty.

Schwannoma (neurilemmoma) of tongue: A rare case presentation and review of literature.

It seems that schwannomas of the tongue base originate from branches of the glossopharyngeal, vagus, or hypoglossal nerves. Additionally, complete trans-oral surgical excision is an efficient method to remove them.

Primary isolated extraluminal hydatid cyst of left pulmonary artery.

Introduction and importance: Hydatid cyst of the pulmonary artery is scarce. There were few reports of intramural involvement of pulmonary artery secondary to cardiac or lung hydatic cyst in the literature. To our knowledge, there was no report of a primary isolated extraluminal hydatid cyst of the left pulmonary artery. Case presentation: A twenty-eight-year-old female presented to the hospital with a complaint of progressive dyspnea. The patients had no common COVID-19 infection symptoms. Clinical discussion: The RT-PCR for COVID-19 RNA was negative. A spiral chest CT scan demonstrated a cystic mass sized 83 × 34 in the middle mediastinum. Intraoperatively, the intrapericardial mass arises from the left pulmonary artery and extends to the hilum of the left atrium. The mass was resected, and the pathology report noted a hydatid cyst. The postoperative course was uneventful, and the patient was discharged with the administration of albendazole for three months. Conclusion: Although hydatid cyst primary isolated extraluminal hydatid cyst of the pulmonary artery is extremely rare, in cases with pulmonary artery stenos or hypertension manifestation, a probable differential diagnosis should be considered.

The stage of head and neck diagnosed malignancies in COVID-19 outbreak versus before outbreak: A retrospective study.

BACKGROUND: Global COVID-19 pandemic has affected cancer care systems. Recent studies show that the number of cases diagnosed with cancer has drastically decreased compared to the same period before the pandemic. Therefore, we are confronted with delayed diagnosis of critical cancers. AIM: The aim of this study is to investigate whether the stage of known cancers has been affected by delayed diagnosis and to compare the stages of head and neck cancers diagnosed during and before the pandemic. METHODS: The present study was conducted on 132 patients with malignant head and neck tumors referred to the otolaryngology, head and neck cancer department of Taleghani Hospital from 2019 to 2021. The stage of cancers was compared between two groups of patients with head and neck malignancy referred to the Otolaryngology, Head and Neck Department of the Taleghani Hospital before and during the COVID-19 outbreak. RESULTS: The results from tumor (T), nodes (N), and metastases (M) (TNM) staging (p-value = .015) and T score (value = 0.045) showed that the stage of tumor diagnosed in patients during the COVID-19 pandemic significantly increased compared to patients diagnosed with a tumor before pandemic. CONCLUSION: In the present study, it was observed that the early symptoms of malignant head and neck tumors have been neglected by patients during COVID-19 pandemic and resulted in delayed diagnosis. This result may be explained by the fear of COVID-19 infection in patients, which discouraged them from visiting a doctor at healthcare centers.

Potentially fatal atrium perforation due to right jugular vein catheterization recognized by venography: A case report.

Central venous catheters are the prevalent path for dialysis. Our case was a 54-years-old male with a new case of end-stage renal disease with a complaint of right jugular hemodialysis catheter dysfunction. In our case, the early dysfunctional catheter should be evaluated with contrast studies to achieve accurate information.

Reasons for Preoperative Patient Attrition among Bariatric Surgery Candidates: Patients' Point of View.

PURPOSE: Obesity has become a global health concern, associated with decreased quality of life and life expectancy. Although bariatric surgery has many benefits (e.g., substantial and durable weight loss, amelioration of comorbidities, and improvement in functionality), its patient attrition rate is relatively high. Therefore, we aim to assess the causes of withdrawal from our program. MATERIALS AND METHODS: We interviewed patients who dropped out of our bariatric surgery program between January 2016 and December 2021. A total of 1999 patients were eligible for bariatric surgery during this period, and 255 patients withdrew from the program. We interviewed patients over the phone to find out the reason for withdrawal. We divided participants into two groups: dropouts before and during the COVID-19 pandemic. Several options explaining the reason for leaving the program were presented to the patients to choose from. RESULTS: The number of patients who withdrew from the program before and during the COVID-19 pandemic was 135 (8.9%) and 120 (25.2%), respectively. Before the COVID-19 pandemic, most patients (49.1%) stated that the long waiting time was the cause of withdrawal. Even though during the COVID-19 pandemic, the main causes of attrition were the fear of contracting the disease and COVID-19 infection; the most common reason unrelated to COVID-19 was still the long preoperative preparation. CONCLUSION: Long waiting time was the most common cause of patient attrition before bariatric surgery. To reduce the attrition rate, more studies should be conducted to find an optimized waiting time before bariatric surgery.

The Impact of Covid-19 Pandemic on Genitourinary Cancers Stage and Grade.

INTRODUCTION: Our study aims to evaluate the impact of the COVID-19 pandemic on the number of uro-oncological surgeries (cystectomy, nephrectomy, prostatectomy, orchiectomy, and transurethral resection of bladder tumor (TURBT)) and pathological staging and grading. MATERIALS AND METHODS: The present study is a retrospective study on patients with genitourinary cancers treated from 2018 to 2021 in a referral tertiary center. The data were obtained from the hospital records with lengths of 22 and 23 months, labeled hereafter as non-COVID and COVID pandemic, respectively (2018/3/21-2020/1/20 and 2020/1/21-2021/12/21). The total number of registered patients, gender, age, stage, and grade were compared in the targeted periods. Moreover, all the pathologic slides were reviewed by an expert uropathologist before enrolling in the study. The continuous and discrete variables are reported as mean (standard deviation (SD)) and number (percent) and the χ2 test for the comparison of the discrete variables' distribution. RESULTS: In this study total number of 2077 patients were enrolled. The number of procedures performed decreased during the Covid pandemic. The tumors' distribution stage and grade and patients' baseline characteristics were not significantly different in non-COVID and COVID pandemic periods for Radical Nephrectomy, Radical Cystectomy, Radical Prostatectomy, and orchiectomy. For TURBT only, the tumor stage was significantly different (P-value<.001) from the higher stages in the COVID pandemic period. CONCLUSION: Among urinary tract cancers, staging of bladder cancer and TURBT are mainly impacted by the COVID-19 pandemic with higher stages compared to the non-COVID period. We evaluate the impact of the COVID-19 pandemic on the number of uro-oncological surgeries based on pathological staging and grading. Total number of 2077 patients were enrolled. Among urinary tract cancers, staging of bladder cancer and TURBT are mainly impacted by the COVID-19 pandemic with higher stages compared to the non-COVID period.

The Gene Manipulation and Cellular Immunotherapy Combination in the Treatment of Cancer.

Context: The immune system is directly linked to the tumors, from tumor formation to the tumor's development and metastasis. So, the interest of scientists over the protective immunological mechanisms has increased and shown gifted strategy in cancer treatment. Evidence acquisition: Genetic engineering and cellular immunotherapy are two different advanced molecular mechanisms to modify the immune responses and genome. Gene manipulation is the bioengineering technology that allows vectors to transfer new genetic information into the target cells. Cellular immunotherapy is an excellent strategy that connects the body's immune system to fight cancer. Results & Conclusions: This review described that combination of genetic engineering and cellular immunotherapy has brought the novel antitumor repressive molecules stopping the tumor tissue immune tolerance and significantly expanding cancer therapy's effectiveness. Usually, cell immunotherapy and genetic engineering are considered two independent processes, and, in this review, we believe them in combinations. Here, we review these two novel approaches, and they are both combinations in terms of technological advances and clinical experience.

The importance of personalized medicine in urological cancers.

A better understanding of key regulatory pathways involved in cancers has led to the development of molecularly targeted therapies. Molecular profiling based on genomics, proteomics, and metabolomics in tumors provides clinicians with the necessary information to maintain a personalized therapeutic regimen according to the patient's needs. for example, androgen deprivation therapy (ADT) for advanced prostate cancer is one of the earliest forms of targeted therapy and has remained a choice of treatment by physicians. Unfortunately, most patients will eventually become non-responsive to ADT and succumb to the disease. Since the emergence of ADT, the understanding of androgen receptor (AR) signaling and mechanisms driving the resistance to ADT has been significantly improved. Inactivation of the PTEN gene is a common occurrence in prostate cancers and is associated with metastatic potential, androgen independence, and poor prognosis. Several studies over personalized medicine for muscle-invasive and metastatic bladder cancer discussed potential molecular biomarkers which are currently under investigation and based on the excision repair cross-complementing group 1 (ERCC1) gene and its role in tumor development and therapeutic resistance to cytotoxic DNA-damaging chemotherapy and ionizing radiation. In this review, we consider personalized medicine for four urological cancers.

Comparative evaluation of normal saline, 1/3-2/3, and ringer's lactate infusion on labour outcome, PH, bilirubin, and glucose level of the umbilical cord blood in nulliparous women with labour induction: a randomised clinical trial.

This study aimed to compare the effects of infusion of normal saline, 1/3-2/3, and Ringer's lactate fluids on labour outcome, pH, bilirubin, and glucose level of umbilical cord blood. In this randomised clinical trial, 450 nulliparous women with Bishop score ˂5 and indication of pregnancy termination were randomly divided into three groups to receive normal saline, 1/3-2/3, or Ringer's lactate infusion at a rate of 125 mL/h for hydration, upon starting induction of labour. Results of this study indicated that the incidence of hypoglycaemia (p = .19), hyper bilirubinemia (p = .87) and acidosis (p = .10) was similar in neonates of the three groups. Also, there were no statistically significant differences between the three groups with regard to the duration of labour; glucose, bilirubin and pH level of cord blood; and mode of delivery. It can be concluded that infusion of Ringer's lactate, normal saline or 1/3-2/3 fluid during labour is not associated with different maternal or foetal/neonatal outcomes, and none of the fluids has superiority to the others.Impact statementWhat is already known on this subject? Several studies have been conducted on the association between type and volume of infused fluid on labour duration and neonatal outcomes. However, there has been some controversy.What do the results of this study add? This is the first study that has investigated the association between infusion of Ringer's lactate, normal saline or 1/3-2/3 fluid during labour with labour outcome and pH, bilirubin, and glucose level of the umbilical cord blood and results showed that these fluids have no effect on maternal or foetal/neonatal outcomes and also none of these fluids has superiority to the others.What are the implications of these findings for clinical practice and/or further research? Due to contradictory results of previous studies, further research with greater sample sizes and different fluids type and volumes may be needed to examine the association between infusion of fluids and neonatal and labour outcomes more precisely.

Intra-articular osteoid osteoma of the capitulum: A diagnostic challenge.

Here, we describe the first case of intra-articular osteoid osteoma of the capitulum, which is presented as elbow pain, extension lack, and sensation of click in joint flexion. Surgical treatment either arthroscopic or open is more in use in this location of the tumor than cortical osteoid osteoma.

Human prostate cancer cell epithelial-to-mesenchymal transition as a novel target of arsenic trioxide and curcumin therapeutic approach.

BACKGROUND: Arsenic trioxide (As2O3) as an inorganic compound is used to treat various cancers and other diseases. It has been reported that arsenic trioxide induced cellular apoptosis in certain kinds of cancers, including prostate cancers. The present study aimed to elucidate the crucial cooperative role of arsenic trioxide and Curcumin and their ability to protect against prostate cancers by targeting the epithelial-to-mesenchymal transition and expression of apoptosis-related genes. MATERIAL AND METHODS: The human prostate cell lines (LNCaP and PC3) were treated with different concentrations of Curcumin and As2O3 alone and combined to find effective doses and IC50 values. Percentages of apoptotic cells were evaluated by Annexin/P.I. staining, the proliferative inhibitory effect was assessed by Micro Culture Tetrazolium Test (MTT), and mRNA levels of KLK2, E-cadherin, SNAIL, angiogenesis genes (VEGFA and VEGFC), and apoptosis genes (BAX, Bcl2, and P53) expression were investigated by the real-time PCR method. ANOVA and t-test were used to appraise the results. RESULTS: For the first time, we presented that the combination therapy of Curcumin and As2O3 increases prostate cancer cell apoptosis and inhibits proliferation; Our data displayed that Curcumin (15 µM and 10 µM in PC3 and LNCap), As2O3 (8 µM and 5 µM in PC3 and LNCap), and also their combination (15 µM Curcumin and 8 µM As2O3 in PC3, 10 µM Curcumin and 5 µM As2O3 in LNCap cell lines) significantly increased the percentage of apoptotic cells and inhibited cell growth (P < 0.05) compared with each drug alone. Generally, both cell lines treated with the combination of Curcumin and As2O3 displayed decreased angiogenesis genes (VEGFA and VEGFC), apoptosis genes (BAX and Bcl2), and prostate cancer marker (KLK2), the zinc-finger protein (SNAIL); and an increase in expression (P < 0.05) of cell-cell adhesion molecule (E-cadherin) and tumor suppressor gene (P53) genes. CONCLUSIONS: The antitumor effects of combination therapy with As2O3 and Curcumin have been displayed on prostate cancer cell lines (LNCaP and PC3), which probably originates from their potential to induce apoptosis and inhibit the growth of prostate cancer cells simultaneously.