Early vs. delayed QTc prolongation in acute poisoning: A prognostic accuracy study-A case series.

Given the limited capacity of intensive care units in many countries, it is crucial to identify reliable prognostic markers to optimize poisoning patients management and improve outcomes. This study aimed to assess the predictive value of three variables, namely the initial QTc interval (iQTc) measured within two hours of admission, the delayed QTc interval (dQTc) measured between 6 and 12 hours of entry, and the QTc interval trend over time (ΔQTc), for mortality in patients with undifferentiated poisoning. A retrospective case series was conducted on 70 patients with undifferentiated poisoning admitted to the intensive care unit (ICU) of Afzalipour Hospital between March 21, 2021, and March 20, 2023. The results of the multivariate analysis revealed that dQTc, base deficit, and creatinine were independently associated with mortality (P value < 0.001). The dQTc had the highest predictive ability, with an area under the curve (AUC) of 0.84, followed by ΔQTc with an AUC of 0.76, and iQTc with an AUC of 0.67. Additionally, the results of the Generalized Estimating Equation model with repeated measurements revealed a higher odds ratio for dQTc (OR, 6.33; 95% CI, 2.54-15.79) compared to iQTc (OR, 4.92; 95% CI, 1.71-14.17). The study concluded that monitoring the dQTc interval could provide valuable prognostic information in acute poisoning cases.

Descriptive analysis of therapeutic outcomes between thoracoscopic and transsternal thymectomy in myasthenia gravis patients from 2011 to 2021.

BACKGROUND: Myasthenia gravis is an autoimmune disease with high prevalence of thymus disorders, in which, thymectomy is considered one of the therapeutic approaches in improving the patients' clinical outcomes. Today, thoracoscopic thymectomy has received significant attention than the classic transsternal approach due to fewer complication. Therefore, this study was designed with the aim of investigating the therapeutic outcomes of thymectomy in patients with myasthenia gravis in the Afzalipour Hospital of Kerman between 2011 and 2021. METHODS: The current study is a descriptive analytical study on patients with myasthenia gravis who underwent surgical thymectomy within 2011-2021. Demographic and clinical characteristics of patients from the time of operation to three years of follow-up were extracted and recorded from clinical records or by phone calls. Data were analyzed using SPSS software. RESULTS: The data of 70 patients who underwent surgical thymectomy were analyzed. Thymectomy caused a significant reduction in the severity of the disease according to the Osserman classification (P = 0.001). It also significantly reduced the use of corticosteroids (P = 0.001) and IVIG (P = 0.015) compared to the time before the surgery. Sixty-two patients (88.57%) needed to take less medicine than before surgery. Left VATS was associated with less post-operative severity of the disease (P = 0.023). There were only two deaths during the follow-up period. CONCLUSION: Overall, the findings of the present study demonstrated that thoracoscopic thymectomy is a useful surgical approach that leads to faster recovery, reducing the severity of the disease, need for medication, and complications in patients with myasthenia gravis, In comparison with the transsternal approach.

Navigating treatment for basidiobolomycosis: a qualitative review of 24 cases.

BACKGROUND AND OBJECTIVES: Zygomycosis, a severe form of fungal infection, is classified into two categories: Mucorales and Entomophthorales. Within the Entomophthorales category, Basidiobolomycosis is a rarely recognized genus that can have significant health implications. Prompt diagnosis and appropriate treatment, which includes the use of antifungal medication and surgical procedures, are vital for enhancing the prognosis of patients. The objective of this study is to investigate the response to treatment in patients hospitalized due to basidiobolomycosis. METHODS: We carried out a retrospective study, in which we analyzed data from 49 patients who were diagnosed with Entomophthorale, Zygomycosis, and Basidiobolomycosis at Namazi Hospital, Shiraz, between the years 1997 and 2019. The data included parameters such as demographic information, clinical symptoms, imaging findings, treatment methods, and patient outcomes. RESULTS: Out of 49 patients, 24 children, predominantly male (83.3%), were definitively diagnosed with basidiobolomycosis. The ages of the patients ranged from 1 to 16 years, with an average of 5.75 years. The most frequently observed clinical manifestations included abdominal pain (70.8%), fever (54.2%), hematochezia (41.7%), vomiting (20.8%), and anorexia (16.7%). Half of the patients exhibited failure to thrive (FTT), while abdominal distension was present in 25% of the cases, and a palpable abdominal mass was found in 37% of the patients. The primary treatment strategy incorporated surgical interventions complemented by a comprehensive antifungal regimen. This regimen included medications such as amphotericin B, cotrimoxazole, itraconazole, potassium iodide, and voriconazole. These were mainly administered in a combination therapy pattern or as a monotherapy of amphotericin B. Twenty-two patients were discharged, while two patients died due to complications from the disease. CONCLUSION: Our findings indicate that the prevailing treatment modalities generally involve surgical intervention supplemented by antifungal regimens, including Amphotericin B, Cotrimoxazole, Potassium Iodide, and Itraconazole.

Mechanistic insights into circRNA-mediated regulation of PI3K signaling pathway in glioma progression.

Circular RNAs (CircRNAs) are non-coding RNAs (ncRNAs) characterized by a stable circular structure that regulates gene expression at both transcriptional and post-transcriptional levels. They play diverse roles, including protein interactions, DNA methylation modification, protein-coding potential, pseudogene creation, and miRNA sponging, all of which influence various physiological processes. CircRNAs are often highly expressed in brain tissues, and their levels vary with neural development, suggesting their significance in nervous system diseases such as gliomas. Research has shown that circRNA expression related to the PI3K pathway correlates with various clinical features of gliomas. There is an interact between circRNAs and the PI3K pathway to regulate glioma cell processes such as proliferation, differentiation, apoptosis, inflammation, angiogenesis, and treatment resistance. Additionally, PI3K pathway-associated circRNAs hold potential as biomarkers for cancer diagnosis, prognosis, and treatment. In this study, we reviewed the latest advances in the expression and cellular roles of PI3K-mediated circRNAs and their connections to glioma carcinogenesis and progression. We also highlighted the significance of circRNAs as diagnostic and prognostic biomarkers and therapeutic targets in glioma.

Empyema necessitans as a rare manifestation of Staphylococcus aureus.

Empyema necessitans (EN) is a rare complication of empyema, in which pus accumulates within the pleural space and spreads through the chest wall, leading to the formation of a subcutaneous abscess. This condition presents significant diagnostic and therapeutic challenges due to its rarity and potential for serious complications. Here, we present the case of an 8-year-old boy with a history of parapneumonic effusion that was incompletely treated due to a lack of fibrinolytic agent injection. He presented with fever, chills, a productive cough, and left-sided chest pain with yellowish purulent secretions from the left chest wall. The patient was diagnosed with EN caused by Staphylococcus aureus, which has occurred due to inadequate treatment and the lack of administration of a fibrinolytic agent injection for the patient. He was treated with broad-spectrum antibiotics, video-assisted thoracic surgery, and a chest tube for complete drainage. The patient showed a smooth and uneventful recovery, highlighting the importance of early diagnosis and prompt treatment of EN to avoid further complications. This case report aims to increase awareness among clinicians about the importance of early recognition and appropriate management of EN to improve patient outcomes.

A review of isotretinoin in the treatment of frontal fibrosing alopecia.

INTRODUCTION: Frontal fibrosing alopecia (FFA) is characterized by scarring alopecia of the frontotemporal scalp and facial papules. Isotretinoin is a vitamin A-derived retinoid discovered in 1955 and approved for treating nodulocystic acne. This drug can also affect facial papules and frontotemporal hair loss in patients with FFA. In this article, we conducted a review of the available studies investigating the use of oral isotretinoin for FFA treatment. Our study provides insights into the efficacy and safety of isotretinoin as a potential treatment option for FFA and highlights areas for future research. METHOD: In this study, we aimed to investigate the potential advantages and disadvantages of isotretinoin as a treatment for FFA. To identify all relevant articles, we developed a comprehensive search strategy and conducted a thorough search of three major databases: PubMed, Embase, and Science Direct. We retrieved a total of 82 articles from the search results. Two independent reviewers then screened each of the 82 articles based on our inclusion and exclusion criteria, resulting in the identification of 15 articles that were deemed relevant to our study. RESULTS: Across the 15 articles, 232 patients who suffered from FFA were involved. Nearly 90% of patients experienced a significant reduction of symptoms after receiving oral isotretinoin at 10-40 mg daily. We conclude that isotretinoin can positively affect facial papules and help suppress hair loss.

Efficacy and safety of topical brimonidine in dermatology: A review article.

Brimonidine is a vasoconstrictive agent used to treat several dermatologic disorders. Here, we review the uses of brimonidine in different aspects of dermatology. We searched keywords including rosacea, erythema, topical brimonidine, dermatology, and skin disease in PubMed, Cochrane, and Google Scholar to collect the related published articles. In a review of 15 articles, we found topical brimonidine improved the facial erythema of rosacea. In addition, it reduced the erythema associated with alcohol flushing syndrome, intense pulsed light therapy, and photodynamic therapy. Furthermore, topical brimonidine was used as a hemostatic agent in dermatosurgery procedures such as Mohs surgery and nail surgery to reduce intra-operative and postoperative bleeding. Some side effects such as erythema, flushing, and burning were reported in a few patients. Based on our findings, brimonidine is a beneficial drug that can be used in various dermatologic disorders with negligible side effects.