Complex Presentation of a Dieulafoy Lesion in a Geriatric Patient with Multiple Comorbidities.

Dieulafoy lesions (DL) consist of tortuous, thick-walled submucosal arteries that protrude through a small mucosal defect, often surrounded by otherwise normal mucosa. They are commonly located in the proximal stomach, particularly along the lesser curvature and near the esophagogastric junction, typically within 5 cm. However, they can also occur in various other regions of the GI tract, including the esophagus, duodenum, and colon. We present the case of a 76-year-old female with a complex medical history who arrived at the ED with hematemesis and melena. Her condition rapidly deteriorated; her blood pressure significantly dropped. Upon stabilization, upper endoscopy uncovered a 5-cm red lesion near the gastroesophageal junction, indicative of DL. Immediate intervention with clips was successful. Following the procedure, while the patient was in the ICU, she started to experience left-sided chest pain and diaphoresis, leading to the suspicion of acute coronary syndrome. Further investigations revealed non-ST-elevation myocardial infarction (NSTEMI). This case highlights the life-threatening nature of upper GI bleeding, especially in elderly patients with multiple comorbidities and extensive medication regimens. Timely diagnosis and intervention for DL are crucial, particularly in elderly patients with multiple health comorbidities. This underscores the significance of prompt medical attention and intervention in such complex scenarios.

miR-185 and SEPT5 Genes May Contribute to Parkinson's Disease Pathophysiology.

There are still unknown mechanisms involved in the development of Parkinson's disease (PD), which elucidating them can assist in developing efficient therapies. Recently, studies showed that genes located on the human chromosomal location 22q11.2 might be involved in the development of PD. Therefore, the present study was designed to evaluate the role of two genes located on the chromosomal location (miR-185 and SEPT5), which were the most probable candidates based on our bibliography. In vivo and in vitro models of PD were developed using male Wistar rats and SHSY-5Y cell line, respectively. The expression levels of miR-185, SEPT5, LRRK2, and PARK2 genes were measured at a mRNA level in dopaminergic areas of rats' brains and SHSY-5Y cells using the SYBR Green Real-Time PCR Method. Additionally, the effect of inhibition on the genes or their products on cell viability and gene expression pattern in SHSY-5Y cells was investigated. The level of miR-185 gene expression was significantly decreased in the substantia nigra (SN) and striatum (ST) of the rotenone-treated group (control group) compared to the healthy normal group (P < 0.05). In addition, there was a significant difference in the expression of SEPT5 gene (P < 0.05) in the substantia nigra between two studied groups. The results of an in vitro study showed no significant change in the expression of the genes; however, the inhibition on miR-185 gene expression led to the increase in LRRK2 gene expression in SHSY-5Y cells. The inhibition on LRRK2 protein also decreased the cellular toxicity effect of rotenone on SHSY-5Y cells. The results suggested the protective role of miR-185 gene in preventing the development of PD.

The effects of cinnarizine versus sodium valproate in migraine prophylaxis.

AIM: The aim of this randomized, double-blind, parallel-group study was to compare the efficacy and safety of low-dose cinnarizine and sodium valproate in migraine prophylaxis. METHODS: A total of 104 patients were treated during a 12-week treatment period. Cinnarizine dose of 25 mg and 200-mg sodium valproate were administered every 12 hours. During follow-up period, frequency, intensity and duration of migraine attacks, symptoms associated with headache, analgesics use, as well as drugs' side effects were studied. Participants completed Migraine Disability Assessment (MIDAS) and Headache Impact Test (HIT-6) questionnaires before and after treatment. RESULTS: Frequency, intensity and duration of migraine headaches as well as MIDAS score and administration of symptomatic medications decreased significantly between repeated follow-up visits in both groups. Reduction of 4-week migraine frequencies in patients receiving cinnarizine and valproate was 36.4% and 55%, respectively, and the difference between two groups was statistically significant (p < 0.001). CONCLUSION: Our results showed that administration of 25-mg cinnarizine every 12 hours can significantly decrease headache duration (p ≤ 0.001) and headache frequency (p ≤ 0.001) in patients with migraine. These results suggest that cinnarizine may be an appropriate substitution for first-line migraine prophylaxis such as valproate.