Laparoscopic gastric plication: A long-term follow-up and comparison of outcomes in severe vs. non-severe obesity.

BACKGROUND: LGGCP is a non-gastrectomy, restrictive bariatric technique. This study aims to assess its long-term efficacy. METHODS: This is a retrospective cohort study on LGGCP patients (2010-2019) from a single tertiary center, followed for up to 60 months. RESULTS: Ninety-four patients with obesity were included in the study. The mean five-year postoperative BMI was 32.00. Excess weight loss (EWL): 30%-50% and EWL<30% occurred in 16 and 9 cases, respectively. The mean EWL was higher at 3-, 6-, and 12- months post-operation in patients with a BMI<40. Weight regain was 46.3% at the five-year follow-up. Eighty-seven patients had associated comorbidity, and 76 had improved in at least one of their comorbidities. Sixteen patients (17.0%) experienced complications. CONCLUSION: LGGCP is safe and effective, with benefits in patients with BMI<40. Thus, we suggest the usage of LGGCP, especially in this group of patients, due to its less-invasive nature and acceptable cost-benefit. Further studies with larger sample sizes are required for validation.

Association of alternative healthy eating index and severity of pemphigus vulgaris: A cross-sectional study.

BACKGROUND: Evidence on the association between following healthy eating and the severity of pemphigus vulgaris (PV) is scarce. Therefore, the aim of this cross-sectional study aimed to investigate the relationship between adherence to the alternative healthy eating index (AHEI) and the severity of Pemphigus vulgaris disease in adults. METHODS: In this hospital-based cross-sectional study, a total of 138 pemphigus vulgaris cases were studied, of which 108 had pemphigus disease area index (PDAI) ≤15, and 30 had PDAI>15. Dietary intakes were assessed using a valid 168-item food frequency questionnaire (FFQ). To calculate the AHEI, the data received from the diet were used. The subjects of this index received a score of 1-10. The final AHEI was calculated by summing the component scores. RESULTS: After adjusting for age and sex, we found that individuals with the highest AHEI score were 72% less likely to have increased PV severity compared with those with the lowest score (OR: 0.28; 95% CI: 0.08-0.92, P trend = 0.020). Further control for another potential confounder, intake energy, made the association stronger (OR: 0.24; 95% CI: 0.06-0.88, P trend = 0.017). Also, after controlling the body mass index (BMI) confounding factor, it maintained its strong relationship (OR: 0.24; 95% CI: 0.06-0.88, P trend = 0.016). CONCLUSION: The evidence of our study shows that following the healthy eating index is associated with a reduction in the severity of pemphigus vulgaris. Prospective cohort studies are needed to confirm these findings.

Comparison of the physical activity levels between shift workers and non-shift workers in a large-scale cross-sectional study in Iran.

BACKGROUND: Shift work has been related to adverse health outcomes that can partially be attributed to physical inactivity. However, our knowledge of the influence of shift work on physical activity and sedentary behavior is inconclusive. Therefore, this study aimed to assess physical activity levels among shift and non-shift workers among a sample of Iranian adults. METHODS: Baseline data of the Ravansar Non-Communicable Disease (RaNCD) cohort study were used. All participants of RaNCD except those excluded due to unemployment or considerable disability were included in the study. We evaluated participants' physical activity levels using the PERSIAN cohort questionnaire and examined its associations with being a shift worker. RESULTS: A total of 4695 participants with a mean age of 46.1 (SD = 7.74) were included in the study. In total, 1108 (23.6%) participants were shift workers, 1420 (30.2%) had insufficient physical activity levels, and 4283 (91.2%) were male. The prevalence of physical inactivity was significantly lower among shift workers compared to non-shift workers (21% vs. 33.1%, p < 0.001). Multiple backward stepwise binary logistic regression tests indicated that being a shift worker was significantly associated with a lower chance of having insufficient physical activity levels (OR = 0.77, 95% CI = 0.65-0.92, p = 0.003). CONCLUSIONS: The prevalence of insufficient physical activity was higher among non-shift workers than shift workers in our study. By providing the factors associated with insufficient physical activity among the workers in a region of Iran, the current study findings might help policymakers target groups at higher risk of physical activity in Iran and design interventions to improve physical activity, especially among non-shift workers.

The association of upper respiratory infections with neuro-radiological course and attack rate of multiple sclerosis: Results from a large prospective cohort.

Background: Although upper respiratory infections (URIs) are linked to multiple sclerosis (MS) attacks, SARS-COV2 has not been compared to URIs for attack rates. Objectives: This study aimed to evaluate the attack rate and the results of neuroimaging in MS patients with URIs caused by COVID-19 and non-COVID-19 infections (NC-URI). Methods: From May 2020 to April 2021, we followed 362 patients with relapsing-remitting MS in a prospective cohort design. Patients were monitored regularly every 12 weeks; an magnetic resonance imaging (MRI) scan was performed at enrollment and every time a relapse occurred. Poisson analysis was used to determine exacerbation rate ratios (RR) and the MRI parameters were tested using chi-square analysis. Results: 347 patients with an average age of 38 and a female ratio of 86% were included. A RR of 2.24 (p < 0.001) was observed for exacerbations during the at-risk period (ARP). Attacks related to COVID-19 (RR = 2.13, p = 0.001) and NC-URIs (RR = 2.39, p < 0.001) were comparable regarding the increased risk of exacerbation (p = 0.62). Exacerbations within or outside the ARP did not significantly alter the number of baseline GAD-enhancing lesions (p > 0.05 for both). Conclusion: COVID-19 has been shown to increase the risk of MS exacerbations, like other viral URIs.

Machine learning for classification of cutaneous sebaceous neoplasms: implementing decision tree model using cytological and architectural features.

BACKGROUND: This observational study aims to describe and compare histopathological, architectural, and nuclear characteristics of sebaceous lesions and utilized these characteristics to develop a predictive classification approach using machine learning algorithms. METHODS: This cross-sectional study was conducted on Iranian patients with sebaceous tumors from two hospitals between March 2015 and March 2019. Pathology slides were reviewed by two pathologists and the architectural and cytological attributes were recorded. Multiple decision tree models were trained using 5-fold cross validation to determine the most important predictor variables and to develop a simple prediction model. RESULTS: This study assessed the characteristics of 123 sebaceous tumors. Histopathological findings, including pagetoid appearance, neurovascular invasion, atypical mitosis, extensive necrotic area, poor cell differentiation, and non-lobular tumor growth pattern, as well as nuclear features, including highly irregular nuclear contour, and large nuclear size were exclusively observed in carcinomatous tumors. Among non-carcinomatous lesions, some sebaceoma and sebaceous adenoma cases had features like high mitotic activity, which can be misleading and complicate diagnosis. Based on multiple decision tree models, the five most critical variables for lesion categorization were identified as: basaloid cell count, peripheral basaloid cell layers, tumor margin, nuclear size, and chromatin. CONCLUSIONS: This study implemented a machine learning modeling approach to help optimally categorize sebaceous lesions based on architectural and nuclear features. However, studies of larger sample sizes are needed to ensure the accuracy of our suggested predictive model.

Indirect immunofluorescence on rat bladder epithelium in patients with pemphigus vulgaris with an extended follow-up.

Background: Indirect immunofluorescence (IIF) on rat bladder epithelium (RBE) has been widely used to detect anti-plakin antibodies present in paraneoplastic pemphigus (PNP). However, anti-plakin antibodies have also been found in a group of patients with pemphigus vulgaris (PV). Objectives: To assess the reactivity rate of PV sera in IIF using RBE as substrate and the diagnostic usefulness of the aforementioned test. Methods: Patients diagnosed with PV presenting to Razi Hospital, Tehran, Iran, were recruited. The patients' demographics, disease severity, and response to the initial treatment were recorded. Sera were collected and tested by IIF on RBE and by desmoglein 3/1 (Dsg 3/1) enzyme-linked immunosorbent assay. Patients were followed up closely for a mean of 53.9 months for any evidence of malignancy. Results: Forty-six patients were enroled (mean age of 42.9 years old, 31 females). Nine sera (19.6%) showed reactivity in IIF on RBE. Mean serum anti-Dsg levels did not differ significantly among the two groups with positive and negative IIF results. Negative anti-Dsg3 was related to a higher positive rate in IIF on RBE. There was no significant correlation between the reactivity of IIF on RBE and patients' demographic, clinical, or serological characteristics. Conclusions: IIF on RBE is a sensitive test for detecting antibodies against plakins. However, it has a relatively high false-positive rate in PV, probably due to the epitope spreading phenomenon. This test should be suggested when there is a clinical or immunohistopathological suspicion of PNP and should be interpreted with caution.

Predictive value of erythrocyte sedimentation rate and C-reactive protein in Behcet's disease activity and manifestations: a cross-sectional study.

BACKGROUND: Behcet's disease (BD) as a chronic inflammatory condition that affects the eyes, skin, central nervous system, gastrointestinal tract and vessels. According to the literature, the exact value of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in predicting active manifestations of BD remains controversial. In this study, we aim to assess and compare values of ESR and CRP between BD patients with active/inactive BD and active/inactive manifestations of the disease. Moreover, we try to determine the predictive value of ESR and CRP for disease activity. METHODS: Participants (n = 514) were drug-naïve BD patients; Based on last two visits, ESR and CRP values, disease activity, and active manifestations were recorded. The Man-Whitney U test measured the associations, and the binomial logistic regression evaluated the predictive value of ESR and CRP for active disease and each active manifestation. The sensitivity and specificity and the area under the curve (AUC) for each model were determined using receiver operating characteristic curves (ROC). Multiple regressions were run to predict BD activity score from ESR and CRP. RESULT: Patients with active oral, genital, joint and dermal manifestations had higher ESR and CRP values (Mann-Whitney U test, p < 0.05 for all). Binomial logistic regressions showed that ESR had valuable predictive value for active BD (OR = 1.09 [1.04-1.13], AUC = 0.79 [0.74-0.83], p < 0.001) and active vascular manifestations (1.03 [1.01-1.05], AUC = 0.85 [0.79-0.92], p < 0.001). CRP had good predictive value for active vascular manifestations (OR 1.98 [1.45-2.72], AUC = 0.86 [0.8-0.91], p < 0.001). The optimal value of ESR ≥ 10.5 and ESR ≥ 42.5 could predict active BD and active vascular manifestations with sensitivity, specificity = 71%, 75% and = 81%, 83% respectively. CONCLUSIONS: ESR and CRP are both associated with active BD and most manifestations of the diseases. They can be used for the prediction of active BD and active vascular manifestations in BD patients. Further studies can help to confirm the findings of the current research.