Type 2 diabetes patients requiring empagliflozin in Southeast of Iran: Frequency and guideline adherence (2022–2023) / Pacientes con diabetes tipo 2 que requieren empagliflozina en el sureste de Irán: frecuencia y cumplimiento de las directrices (2022-2023)

Introduction: Empagliflozin plays a beneficial role in individuals with type 2 diabetes at high risk of cardiovascular complications. This study aimed to assess the prevalence of individuals with type 2 diabetes who required empagliflozin based on clinical guidelines between the years 2022 and 2023. Material and methods: This study was a descriptive-analytical cross-sectional study conducted on a target population of patients with type 2 diabetes. Patient data, including demographic characteristics, smoking status, hypertension, hyperlipidemia, renal insufficiency, retinopathy, and proteinuria, were collected. The indication for prescribing empagliflozin was determined based on the risk of cardiovascular complications. Results: A total of 398 individuals with type 2 diabetes with a mean age of 58.4 years were examined. Overall, 87.4% of the patients had an indication for empagliflozin prescription. The indication for empagliflozin prescription was significantly higher in men, individuals with hyperlipidemia, those over 55 years of age, obese individuals, and smokers. The mean age, body mass index, and triglyceride levels were higher in candidates for empagliflozin prescription. Male candidates for empagliflozin had significantly higher rates of smoking and systolic blood pressure compared to females. Conclusions: The findings of this study demonstrated that a significant percentage of individuals with type 2 diabetes had an indication for empagliflozin prescription based on clinical and laboratory criteria. (AU)

Introducción: La empagliflozina tiene un papel beneficioso en las personas con diabetes tipo 2 con alto riesgo de complicaciones cardiovasculares. Este estudio tuvo como objetivo evaluar la prevalencia de pacientes con este padecimiento que requerían empagliflozina según las guías clínicas entre los años 2022 y 2023. Material y métodos: Se trata de un estudio transversal descriptivo-analítico realizado en una población objetivo de personas con diabetes tipo 2. Se recogieron los datos de los pacientes, incluyendo las características demográficas, el hábito tabáquico, la hipertensión, la hiperlipidemia, la insuficiencia renal, la retinopatía y la proteinuria. La indicación para prescribir empagliflozina se determinó en función del riesgo de complicaciones cardiovasculares. Resultados: Se examinaron un total de 398 individuos con diabetes tipo 2 con una edad media de 58,4 años. En general, 87,4% de estos tenía una indicación para la prescripción de empagliflozina, la cual fue significativamente mayor en los hombres, aquellos con hiperlipidemia, obesidad, los mayores de 55 años y los fumadores. La edad media, el índice de masa corporal y los niveles de triglicéridos fueron mayores en los candidatos a la prescripción de este medicamento. Los candidatos masculinos a este fármaco tenían tasas significativamente más altas de tabaquismo y presión arterial sistólica, en comparación con las mujeres. Conclusiones: Los resultados de este estudio demostraron que un porcentaje significativo de personas con diabetes tipo 2 tenía una indicación para la prescripción de empagliflozina según los criterios clínicos y de laboratorio. (AU)

Type 2 diabetes patients requiring empagliflozin in Southeast of Iran: Frequency and guideline adherence (2022-2023).

INTRODUCTION: Empagliflozin plays a beneficial role in individuals with type 2 diabetes at high risk of cardiovascular complications. This study aimed to assess the prevalence of individuals with type 2 diabetes who required empagliflozin based on clinical guidelines between the years 2022 and 2023. MATERIAL AND METHODS: This study was a descriptive-analytical cross-sectional study conducted on a target population of patients with type 2 diabetes. Patient data, including demographic characteristics, smoking status, hypertension, hyperlipidemia, renal insufficiency, retinopathy, and proteinuria, were collected. The indication for prescribing empagliflozin was determined based on the risk of cardiovascular complications. RESULTS: A total of 398 individuals with type 2 diabetes with a mean age of 58.4 years were examined. Overall, 87.4% of the patients had an indication for empagliflozin prescription. The indication for empagliflozin prescription was significantly higher in men, individuals with hyperlipidemia, those over 55 years of age, obese individuals, and smokers. The mean age, body mass index, and triglyceride levels were higher in candidates for empagliflozin prescription. Male candidates for empagliflozin had significantly higher rates of smoking and systolic blood pressure compared to females. CONCLUSIONS: The findings of this study demonstrated that a significant percentage of individuals with type 2 diabetes had an indication for empagliflozin prescription based on clinical and laboratory criteria.

Comparison of Indocyanine Green Angiography and Fluorescein Angiography for Imaging of Central Serous Chorioretinopathy Patients as Candidates for Photodynamic Therapy.

PURPOSE: To compare fluorescein angiography (FA) and indocyanine green angiography (ICGA) for imaging of central serous chorioretinopathy (CSC) patients. METHODS: The observational cross-sectional clinical study was conducted on 131 eyes of 131 patients with CSC who were candidates for photodynamic therapy (PDT). An experienced ophthalmologist marked the leakage sites and choroidal hyperpermeability sites that needed PDT. For each eye, simultaneous FA and ICGA imaging with the maximum leakage area was selected for comparison regarding the site and size. RESULTS: The mean±standard deviation age of patients was 44.53±9.03 years. Of 226 leakage points, 177 (78.32%) points were in the same site, and 168 (74.34%) points were in the same size on FA. No statistical difference was found between age (P=0.45), sex (P=0.32), and chronicity (P=0.11) of the disease in comparing the ICGA images to the FA images regarding leakage at the same site. A statistically significant difference was also found regarding size of leakage and chronicity (P<0.001). CONCLUSION: The current results suggested that FA could be considered an alternative ocular imaging technology as a guide for PDT in CSC patients.

The lowest uric acid in kidney transplant and review of literature.

Heredity hypouricemia is caused by renal hypouricemia or xanthinuria. Xanthinuria is divided into type 1 with deficiency of xanthine dehydrogenase and type 2 with xanthine dehydrogenase and aldehyde oxidase deficiency. We report a case of xanthinuria type 1 that developed with kidney failure. Hemodialysis was done for him, but kidney function was not improved, so a kidney transplant was performed for him. His serum uric acid was 0.1 mg/dl before and after transplantation.

The interplay between EBV and KSHV viral products and NF-κB pathway in oncogenesis.

Among the DNA tumor viruses Epstein-Barr virus (EBV) and Kaposi sarcoma herpesvirus (KSHV), account for a considerable percentage of virus-associated cancers. Deregulation of transcription factors signaling pathways is one of the most significant oncogenic characteristics of EBV and KSHV. NF-κB is a transcription factor that play a remarkable role in oncogenesis because of its function as a master regulator of a spectrum of genes involved in physiological and pathophysiological process. Constitutive activation of NF-κB is a frequent and well-described event in many human malignancies. Compelling evidence represent EBV and KSHV are capable of targeting different components of NF-κB cascade. Here, we summarized recent findings to clarify the precise relationship between dysregulation of NF-κB and EBV and KSHV-related malignancies. This essay also emphasizes on contribution of various viral products in developing cancer through alteration of NF-κB signaling pathway.

Parity Deformed Jaynes-Cummings Model: "Robust Maximally Entangled States".

The parity-deformations of the quantum harmonic oscillator are used to describe the generalized Jaynes-Cummings model based on the λ-analog of the Heisenberg algebra. The behavior is interestingly that of a coupled system comprising a two-level atom and a cavity field assisted by a continuous external classical field. The dynamical characters of the system is explored under the influence of the external field. In particular, we analytically study the generation of robust and maximally entangled states formed by a two-level atom trapped in a lossy cavity interacting with an external centrifugal field. We investigate the influence of deformation and detuning parameters on the degree of the quantum entanglement and the atomic population inversion. Under the condition of a linear interaction controlled by an external field, the maximally entangled states may emerge periodically along with time evolution. In the dissipation regime, the entanglement of the parity deformed JCM are preserved more with the increase of the deformation parameter, i.e. the stronger external field induces better degree of entanglement.

Population attributable danger of hereditary heart breaks. Risk factors among newborns in Yazd, Iran.

Background: hereditary heart problem are cardiac problems that develop prior to birth and influence the newborns' basic performance of heart. Different kinds of deficiency can range from mild (e.g. a small hole between the heart chambers) to severe (like a flaw or weakness into a heart part). Material & Method: This case-control research performed to evaluate PAR congenital heart defects danger parameters between newborns from 2012 to 2013 in Yazd hospitals. The defects were identified through echocardiography and recorded based on the 10th Revision of Diseases International Classification (DIC10). The total amount of cases were 96, of whom 14 were excluded regarding that the shortage of cooperation or insufficient data. One hundred and sixty five sex and region matched controls selected through random sampling involved in the research. Population Attributable Risk (PAR) utilized to evaluate and measure the priorities of the danger parameters. Finally, the Levin formula utilized to evaluate the regulate community ascribable portion. Result: Regulated odds rates evaluated for the danger parameters. The outcomes revealed that the greatest odds ratio belonged to the maternal history of stillbirth, lack of multivitamin use before pregnancy, maternal obesity, and overweight. The calculation of the adjusted Population Attributable Fraction in risk factors indicated that the highest fraction of the causes of natural heart malformations was associated with overweight and obesity. Conclusion: The current research showed that several factors that can impact the congenital heart defects. It concluded that although overweight and obesity had a weaker association than the other 2 parameters, they have a higher prevalence and a greater attributable risk.

Comparative study of dietary soy phytoestrogens genistein and equol effects on growth parameters and ovarian development in farmed female beluga sturgeon, Huso huso.

Oocyte maturation in fish is a hormonally regulated process. In the light of long-term oocyte maturation in beluga, the aim of this research was to study the estrogenic effects of different concentrations of soy dietary genistein (GE) and equol (EQ) on the growth performance and ovary development in farmed female Huso huso. Fish were fed with concentrations 0 (control), 0.2, 0.4, 0.8 and 1.6 g of EQ and GE per kg of isoproteic (CP 45 %) and isoenergetic (19.5 MJ/kg) diets during a year. Blood samples and ovary biopsies were collected from each fish seasonally. The main results of the present experimentation are that growth performance was not affected significantly both in GE and EQ (P > 0.05). EQ at concentration 0.4 g/kg had more estrogenic effects than other concentrations of EQ and GE in beluga so that 64 % of fish were matured sexually. Some reproductive indices such as oocyte diameter, testosterone (T) and 17ß-estradiol (E2) increased significantly at EQ 0.4 g/kg at the end of experiment (P < 0.05), while 17α-hydroxy progesterone level (17α-OHP) showed no significant changes at all concentrations. Biochemical indices such as calcium, phosphorous and cholesterol increased at GE concentrations, but decreased at EQ concentrations similarly at the end of experiment. There was a negative relationship between plasma phosphorous and alkaline phosphatase enzyme levels. Based on results, EQ at concentration 0.4 g/kg improved oocyte development more than the other concentrations of GE and EQ, and therefore, it can be used as an additive to diets for inducing ovary development in this species.

A comparison of the effect of levonorgestrel IUD with oral medroxyprogesterone acetate on abnormal uterine bleeding with simple endometrial hyperplasia and fertility preservation.

OBJECTIVE: Endometrial hyperplasia is clinically important, because it can lead to abnormal uterine bleeding (AUB) which itself can precede endometrial cancer. Endometrial carcinoma is the most common malignancy of the female genital tract, occurring in about 75%-85% younger, perimenopausal women as endometrial hyperplasia. The treatment is hysterectomy or hormone therapy with progesterone. The aim of this study was, therefore, to compare the effect of levonorgestrel intrauterine device (LNG-IUD) with medroxyprogesterone acetate (MPA) on simple endometrial hyperplasia for fertility preservation. MATERIALS AND METHODS: Forty women in reproductive age (22-47 years) with AUB with endometrial biopsies confirming simple hyperplasia, were enrolled in this study and then randomly divided into two groups. All patients presented with designed special checklist which was filled with satisfaction. Complete history and physical examination especially blood pressure (BP), body mass index (BMI), breast examination, bimanual vaginal examination, and transvaginal sonography (to measure the thickness of endometrial and exclude the other pathologic lesions) were performed. In the first group, treatment was performed with MPA (20 mg/daily) for ten days and in other group with LNG-IUD was prescribed. After three months, transvaginal sonography and biopsy of endometrium were done. The status of AUB and side-effects of two methods,along with the rate of satisfactory were evaluated. RESULT: The findings showed the significant differences in the treatment of simple hyperplasia between two groups (LNG-IUD group vs. MPA group) (p < 0.047). Recovery of AUB in the group LNG was enhanced (p < 0.047). Endometrial thickness was reduced in both groups (p < 0.001), but further reduction in LNG group was seen. Also, LNG was tolerated more than MPA. Side-effects of MPA were more and reached significance (p < 0.003). The rate of satisfaction with LNG was higher than MPA and reached significance (p < 0.048). CONCLUSION: The results of this study show that LNG-IUD is more effective than MPA in treatment of simple endometrial hyperplasia and can be helpful in young women who want to preserve their fertilities.

A unified approach for detection of induced epileptic seizures in rats using ECoG signals.

OBJECTIVE: Epileptic seizure detection is a key step for epilepsy assessment. In this work, using the pentylenetetrazole (PTZ) model, seizures were induced in rats, and ECoG signals in interictal, preictal, ictal, and postictal periods were recorded. The recorded ECoG signals were then analyzed to detect epileptic seizures in the epileptic rats. METHODS: Two different approaches were considered in this work: thresholding and classification. In the thresholding approach, a feature is calculated in consecutive windows, and the resulted index is tracked over time and compared with a threshold. The moment the index crosses the threshold is considered as the moment of seizure onset. In the classification approach, features are extracted from before, during, and after ictal periods and statistically analyzed. Statistical characteristics of some features have a significant difference among these periods, thus resulting in epileptic seizure detection. RESULTS: Several features were examined in the thresholding approach. Nonlinear energy and coastline features were successful in epileptic seizure detection. The best result was achieved by the coastline feature, which led to a mean of a 2-second delay in its correct detections. In the classification approach, the best result was achieved using the fuzzy similarity index that led to Pvalue<0.001. CONCLUSION: This study showed that variance-based features were more appropriate for tracking abrupt changes in ECoG signals. Therefore, these features perform better in seizure onset estimation, whereas nonlinear features or indices, which are based on dynamical systems, can better track the transition of neural system to ictal period. SIGNIFICANCE: This paper presents examination of different features and indices for detection of induced epileptic seizures from rat's ECoG signals.

Comparing letrozole with medroxyprogesterone acetate (MPA) as hormonal therapy for simple endometrial hyperplasia without atypia in adult and middle-aged women.

BACKGROUND: The aim of this survey was to compare the effect of letrozole with medroxyprogesterone acetate (MPA) in treatment of simple endometrial hyperplasia to preserve fertility in young women. MATERIALS AND METHODS: Forty-five patients referred to Shahid Sadoughi gynecology clinics from 2009 until 2011 who suffered from abnormal vaginal bleeding or endometrial thickness, that underwent curettage with diagnosis of simple endometrial hyperplasia without atypia were enrolled. The patients were divided randomly into two groups. First group including 22 women receive ten mg MPA, for ten days during a month for three months. All cases were followed by interview, endometrial curetage, and vaginal sonography. Serum level of estradiol was checked before and after treatment. At the end of the study, biopsy was retaken in 41 patients. All the patients were under observation by two gynecologists. RESULTS: Age range of patients was 20 to 42 years. Mean body mass index (BMI) in the MPA and letrozole groups was 29.13 +/- 4.8 and 25.42 +/- 4.2, respectively. Fifty and 34.8 percent of cases had history of obesity or polycystic ovarian syndrome (PCOS) in MPA and letrozole groups, respectively. Forty-one selected cases (20 of the MPA and 21 of the letrozole groups) continued the treatment for three months. The endometrial thicknesses decreased in both groups. Serum estradiol level also decreased in both groups. The most common complication in the MPA and letrozole groups was headache (27.3%) and flashing and dizziness, respectively. The side-effects were reported less in the letrozole group and the most common ones in this group were dizziness and flashing. DISCUSSION: In women suffering from simple endometrial hyperplasia without atypia, letrozole can lead to decrease of serum estradiol level and endometrial thickness like MPA. In both groups, there was no simple hyperplasia report in curettage report following treatment. It should be noted that there was an incomplete response to treat case with pathology of disordered proliferative type. CONCLUSION: Letrozole is a good therapeutic option in simple endometrial hyperplasia without atypia: cases candidate for medical treatment. To confirm the effect and safety of letrozole, more studies with larger samples are recommended.

Endogenous Klebsiella endophthalmitis associated with liver abscess: first case report from iran.

PURPOSE: To report the first case of endogenous Klebsiella endophthalmitis associated with liver abscess in Iran. CASE REPORT: A 79-year-old man was referred to our hospital due to severe pain and visual loss in the left eye. On physical examination, conjunctival hyperemia, corneal edema, hypopyon and severe vitreous cellular reaction were identified in the left eye; however, yellowish conjunctival discoloration was more apparent in the right eye. Abdominal CT scan showed a right liver lobe abscess that was confirmed by sonographically guided percutaneous liver mass biopsy. Blood, vitreous and liver mass aspirate cultures revealed Klebsiella pneumoniae growth. The patient was thus diagnosed with endogenous Klebsiella endophthalmitis secondary to bacteremia associated with liver abscess. CONCLUSION: This report suggests that, rather than being confined to Taiwan, endogenous endophthalmitis secondary to a liver abscess due to K. pneumoniae may be a global problem. Therefore, physicians should be aware of the possibility of endophthalmitis whenever a patient with K. pneumoniae liver abscess complains of ocular symptoms.

Nonlinear solution for radiation boundary condition of heat transfer process in human eye.

In this paper we propose a new method based on finite element method for solving radiation boundary condition of heat equation inside the human eye and other applications. Using this method, we can solve heat equation inside human eye without need to model radiation boundary condition to a robin boundary condition. Using finite element method we can obtain a nonlinear equation, and finally we use nonlinear algorithm to solve it. The human eye is modeled as a composition of several homogeneous regions. The Ritz method in the finite element method is used for solving heat differential equation. Applying the boundary conditions, the heat radiation condition and the robin condition on the cornea surface of the eye and on the outer part of sclera are used, respectively. Simulation results of solving nonlinear boundary condition show the accuracy of the proposed method.

Conservative surgery in cervical cancer: report of two radical abdominal trachelectomies and literature review.

AIM: Radical trachelectomy or removal of the cervix and uterine ligaments with uterus and ovary preservation is done in primary stages of cervical cancer in women who wish to preserve their fertility. CASES: The first case had cervical cancer in situ with lymphovascular involvement, while the second case had papillary serous adenocarcinoma, Stage Ib1 (lesion < 4 cm and limited to the cervix) diagnosed during pregnancy, who underwent surgery two months following labor. Radical trachelectomy and total pelvic lymphadenectomy to preserve the uterus were done without any intra- or postoperative complications. Both patients had regular postoperative menstruation, but in the second case, the disease relapsed in the vaginal cuff and the patient was a candidate for radical hysterectomy and radiotherapy. CONCLUSION: Radical trachelectomy as a new technique to preserve fertility in early stages of cervical cancer seems to be less effective in adenocarcinoma than squamous cell carcinoma due to a worse prognosis.

Venous ulceration and the measurement of movement: a review.

The anatomical elements of the lower limb work together to optimise venous return. This review examines the mechanisms involved, and the devices available to measure movement, giving opportunities for new preventive interventions.

Discovery of highly potent small molecule kallikrein inhibitors.

Uncontrolled kallikrein activation is involved in diseases such as hereditary angioedema, bacterial septic shock and procedures such as cardiopulmonary bypass. Here we report a series of small molecule compounds that potently inhibit kallikrein activity in vitro. Kinetic studies indicate that some of these compounds are slow binding inhibitors of kallikrein with Ki final less than a nanomolar. The ability of these compounds to inhibit the activity of kallikrein was further confirmed in a plasma model by quantitating the release of bradykinin, an endogenous cleavage product of plasma kallikrein. To understand the inhibitory mechanism of the selected compounds toward kallikrein, the interactions between the selected compounds and kallikrein was explored using molecular modeling based on the information of crystal structures of TF/FVIIa and kallikrein. The information presented in the current study provides an initial approach to develop more selective and therapeutically useful small molecule inhibitors.

A regression model for correcting intraocular lens power after refractive surgery independent of preoperative data.

PURPOSE: To find a method of calculating intraocular lens (IOL) power that may be independent of preoperative data in eyes that have previously undergone myopic laser in situ keratomileusis (LASIK). METHODS: In 148 eyes of 75 patients, before and 6 months after LASIK, IOL power was calculated with SRK/T formula utilizing the spherical equivalent as the desired target refraction. Assuming that LASIK does not alter the crystalline lens refractive properties, IOL calculation error (CER) was estimated with this formula: CER = [pre-LASIK IOL power]/[post-LASIK IOL power]. Then the authors used postoperative biometry and Orbscan II corneal topography data in multiple regression models to find the best variables to predict the CER. Predicted amount of error which is calculated independent of preoperative data could be used to correct the post-LASIK calculated IOL: [corrected post-LASIK IOL power] = CER x [post-LASIK IOL power]. RESULTS: A regression model with these predictors was found: axial length in millimeters (L), radius of the anterior corneal surface best fitted sphere in millimeters divided by radius of the posterior corneal surface best fitted sphere in millimeters (AntBFS/PostBFS), corneal central 5 millimeters mean power in diopters divided by corneal central 3 millimeters mean power in diopters (mean 5 mm/mean 3 mm), the post-LASIK IOL power, and the post-LASIK simulated K reading. The model R square was 0.88. CONCLUSIONS: There is correlation between post-LASIK biometry values and IOL power correction factor. This study presents a new model for further investigation.

Systematic structure-based design and stereoselective synthesis of novel multisubstituted cyclopentane derivatives with potent antiinfluenza activity.

The design and synthesis of novel, orally active, potent, and selective inhibitors of influenza neuraminidase differing structurally from existing neuraminidase inhibitors are described. X-ray crystal structures of complexes of neuraminidase with known five- and six-membered ring inhibitors revealed that potent inhibition of the enzyme is determined by the relative positions of the interacting inhibitor substituents (carboxylate, glycerol, acetamido, hydroxyl) rather than by the absolute position of the central ring. This led us to design potential neuraminidase inhibitors in which the cyclopentane ring served as a scaffold for substituents (carboxylate, guanidino, acetamido, alkyl) that would interact with the four binding pockets of the neuraminidase active site at least as effectively as those of the established six-membered ring inhibitors such as DANA (2), zanamivir (3), and oseltamivir (4). A mixture of the isomers was prepared initially. Protein crystallography of inhibitor-enzyme complexes was used to screen mixtures of isomers in order to identify the most active stereoisomer. A synthetic route to the identified candidate 50 was developed, which featured (3 + 2) cycloaddition of 2-ethylbutyronitrile oxide to methyl (1S,4R)-4[(tert-butoxycarbonyl)amino]cyclopent-2-ene-1-carboxylate (43). Structures of the synthetic compounds were verified by NMR spectroscopy using nuclear Overhauser effect methodology. Two new neuraminidase inhibitors discovered in this work, 50 and 54, have IC(50) values vs neuraminidase from influenza A and B of <1 and <10 nM, respectively. These IC(50) values are comparable or superior to those for zanamivir and oseltamivir, agents recently approved by the FDA for treatment of influenza. The synthetic route used to prepare 50 and 54 was refined so that synthesis of pure active isomer 54, which has five chiral centers, required only seven steps from readily available intermediates. Further manipulation was required to prepare deoxy derivative 50. Because the activities of the two compounds are comparable and 54 [RWJ-270201 (BCX-1812)] is the easier to synthesize, it was selected for further clinical evaluation.