Pulmonary function in children post -SARS-CoV-2 infection: a systematic review and meta-analysis.

OBJECTIVE: There are some concerns regarding long-term complications of COVID-19 in children. A systematic review and meta-analysis was performed evaluating the respiratory symptoms and pulmonary function, post-SARS-CoV-2 infection. METHODS: A systematic search was performed in databases up to 30 March 2023. Studies evaluating respiratory symptoms and pulmonary function after COVID-19 infection in children were selected. The major outcomes were the frequency of respiratory symptoms and the mean of spirometry parameters. A pooled mean with 95% confidence intervals (CIs) was calculated. RESULTS: A total of 8 articles with 386 patients were included in meta-analysis. Dyspnea, cough, exercise intolerance, and fatigue were the most common symptoms. The meta-mean of forced expiratory volume (FEV1) and forced vital capacity (FVC) was 101.72%, 95% CI= (98.72, 104.73) and 101.31%, 95% CI= (95.44, 107.18) respectively. The meta-mean of FEV1/FVC and Forced expiratory flow at 25 and 75% was 96.16%, 95% CI= (90.47, 101.85) and 105.05%, 95% CI= (101.74, 108.36) respectively. The meta-mean of diffusing capacity for carbon monoxide was 105.30%, 95%CI= (88.12, 122.49). There was no significant difference in spirometry parameters before and after bronchodilator inhalation. CONCLUSIONS: Despite some clinical respiratory symptoms, meta-results showed no abnormality in pulmonary function in follow-up of children with SARS-CoV-2 infection. Disease severity and asthma background had not confounded this outcome.

Clinical characteristics and management outcome of acute infectious endophthalmitis.

PURPOSE: This study aimed to investigate the demographics, clinical characteristics, and management outcomes of patients with acute infectious endophthalmitis (AIE). METHODS: This retrospective chart review was conducted on all patients admitted with the clinical diagnosis of infectious endophthalmitis from 2017 to 2022. Demographic data, patients' clinical characteristics, the type of acute infectious endophthalmitis (post-operative, post-traumatic, bleb-associated, and endogenous endophthalmitis), the type of surgical procedure in the post-operative cases, the microbiologic analysis results of vitreous samples, therapeutic measures, and visual outcomes of patients were recorded. RESULTS: In this study, 182 participants, including 122 male (67%) and 60 (33%) female, were involved. The mean age of patients was 54.56 ± 21 years, with a range of 1-88 years old. The most prevalent type of AIE was post-operative (59.9%), followed by endogenous (19.2%), post-traumatic (17%), and bleb-associated (3.8%). The most common type of intraocular surgery in the post-operative subgroups of AIE patients was phacoemulsification (57.8%). The median (interquartile range) of the primary and final BCVA of patients was 1.5 (1.35, 1.85) and 0.65 (0.35, 1.35), respectively. Vitreous haziness grade (OR, 2.89; 95% CI, 1.11-5.74; p = 0.009) and the primary VA (OR, 60.34; 95% CI, 2.87-126.8; p = 0.008) revealed statistical significance for final vision loss. CONCLUSION: AIE is a devastating condition with poor visual outcomes, which presents with acute inflammatory signs and symptoms regardless of its type. However, prompt and appropriate treatment leads to visual recovery to a functional level in many patients.

Evaluation of orbital soft tissue biomechanical parameters in patients with thyroid eye disease using the non-contact Corvis ST.

INTRODUCTION: In thyroid eye disease (TED), all ocular components and adnexa such as extraocular muscles, orbital adipose tissues, eyelids, and tear glands could be affected. This study aimed to study the orbital biomechanical parameters in patients with TED, in terms of differences with healthy individuals and correlation with clinical findings, using Corvis ST (CST, Oculus Wetzlar). MATERIALS AND METHODS: In this study, 26 consecutive patients with TED were recruited. Demographic data were collected, and patients with TED were assessed for exophthalmos, intraocular pressure, and clinical activity score. Biomechanical response parameters of one randomly-chosen eye of each patient, including whole eye movement length (WEMl) and time (WEMt), were evaluated by the CST, and data were compared between patients and age- and gender-matched healthy controls. RESULTS: The mean age was 39.88 ± 11.61 years old for patients with TED and 34.38 ± 8.57 years old for the healthy subjects. Nine out of 26 patients with TED and nine of 26 healthy individuals were male. The median duration of thyroid disease was 36 (IQR 54) months and the median duration of thyroid ophthalmopathy was 27 (IQR 27) months. Four out of 26 patients (7.7%) had active disease. The mean WEMl was 206.15 ± 61.58 µm in the TED group and 254.23 ± 64.01 µm in the healthy group, the difference of which was statistically significant (p = 0.008). The median of WEMt was 20.90 (1.15) msec in the TED group and 21.45 (0.93) msec in the healthy group (p < 0.001). Also, the mean of WEMl and WEMt were lower in patients with active disease compared to patients with quiescent disease. CONCLUSION: The CST-derived WEMl was significantly smaller in patients with thyroid eye disease compared to normal subjects. The WEMl and WEMt were relatively shorter in the patients with active TED compared to the patients with quiescent TED, although small numbers of patients with active TED limits took a statistically significant conclusion. WEMl and WEMt might be useful in evaluating the compliance of the orbit in patients with TED.

Evaluation of the Effect of Religious Fasting on Retinal Vessel Density and Retinal Thickness Using Optical Coherence Tomography Angiography.

We conducted this study to assess the effect of religious fasting on intraocular pressure (IOP) as well as retinal parameters and retinal thickness during Ramadan using optical coherence tomography angiography (OCTA) performed on a spectral domain device. All the participants ate a pre-dawn meal and drink, and then fasted for at least 15 hours. We assessed a total of 61 eyes from 31 healthy volunteers with a mean age of 32.87 ± 8.07. A significant decrease was found in the median IOP after fasting at 10.00 mmHg in comparison with the pre-fasting value of 12.00 mmHg (p < .0001). Retinal peri-papillary capillary (RPC) whole image, RPC inside disk, and RPC mean values showed significant decreases after fasting (p = .011, .012, and .032 respectively). RPC whole vessel density (VD), RPC inside VD, and RPC VD mean values also showed significant decreases after fasting period (p = .025, <.0001, and .003, respectively). Religious fasting during the warm season could decrease IOP. It could also reduce the blood flow of the retina, specifically the macula, and the retinal peri-papillary VD.

Synergistic, cytotoxic and apoptotic activities of olmesartan with NF-κB inhibitor against HeLa human cell line.

CONTEXT: Over expression of renin-angiotensin system (RAS) and nuclear factor-kappaB (NF-κB) has a major role in many cancers. It has been suggested that some angiotensin receptor blockers (ARBs) could reduce the proliferation of cancer cells. The role of NF-κB pathway has been documented in cell proliferation. OBJECTIVE: In this study, the role of angiotensin II and NF-κB pathway in human cervical cancer cell line (HeLa) proliferation was studied using olmesartan (as a novel Ag II antagonist) and Bay11-7082 (as NF-κB inhibitor). MATERIALS AND METHODS: HeLa cells were treated with different concentrations of olmesartan and Bay11-7082. Cell proliferation was determined after 24, 48, and 72 h by MTT assay. Synergistic activity of olmesartan with Bay11-7082 was analyzed with Compusyn software. Apoptotic cells were determined using PI staining of DNA fragmentation. RESULTS: Cell viability decreased with olmesartan and Bay11-7082 in HeLa cells by 24, 48 and 72 h. Olmesartan had synergistic activity with Bay11-7082 and combinations of olmesartan with Bay11-7082 decreased cell viability as compared with single agent treatments. Olmesartan and Bay11-7082 induced a sub-G1 peak in flow cytometry histogram of treated cells indicating that apoptotic cell death is involved in olmesartan and Bay11-7082-induced toxicity. DISCUSSION AND CONCLUSION: Results imply that olmesartan and Bay11-7082 inhibit the growth of HeLa cells as a concentration- and time-dependent mode and they have synergistic activity. Results show that RAS and NF-κB pathway blockade lead to significant cytotoxicity against tumor cell line. So, ARBs and NF-κB pathway inhibitors could be considered as good anti-cancer agents in cervix carcinoma after further studies.

Efficacy and Safety of Allopurinol on Chronic Kidney Disease Progression: A Systematic Review and Meta-Analysis.

OBJECTIVE: Hyperuricemia is associated with the progression of chronic kidney disease (CKD). Whether urate-lowering treatment with allopurinol can delay disease progression remains controversial. METHODS: Relevant databases were searched. Randomized clinical trials comparing the efficacy and -safety of allopurinol in patients with CKD were selected. The primary outcomes were changes in serum uric acid concentration and estimated glomerular filtration rate (eGFR). Random-effects modeling was used to -calculate the standard mean difference (SMD) with 95% CIs. RESULTS: Four trials enrolling 698 participants were included. All were 2-arm parallel trials with a mean duration follow-up of 22.5 months. Congenital anomalies of the kidney and urinary tract were the most common cause of CKD in children, whereas diabetes was the leading cause of CKD in adults. Allopurinol significantly increased the eGFR compared with control groups (SMD, 2.04; 95% CI, 0.60-3.49; p = 0.005; I2 = 98.23%). Allopurinol led to a significant decrease in serum uric acid concentration compared with the control group (SMD, -5.16; 95% CI, -8.31 to -2.01; p = 0.001; I2 = 98.80%). No significant difference in adverse effects was identified between treatment and control groups. CONCLUSIONS: Allopurinol treatment in patients with CKD and hyperuricemia slows the decline in eGFR as compared with placebo, without risk of increased adverse effects.

Intravenous Tranexamic Acid for Control of Bleeding during External Dacryocystorhinostomy under General Anesthesia: A Randomized Clinical Trial.

Purpose: To investigate the effect of intravenous tranexamic acid administered prior to external dacryocystorhinostomy (DCR) surgery to decrease intraoperative bleeding under general anesthesia. Methods: This was a double-blinded randomized placebo-controlled trial. A total of 70 patients (35 intervention and 35 control) with nasolacrimal duct obstruction (NLDO) who were selected for DCR surgery between September 2021 and September 2022 were included. After clinical examinations and laboratory tests, patients were randomly classified into intervention and control groups. The intervention group received 10 mg/kg intravenous tranexamic acid to a maximum dose of 1 gr 30 minutes before the surgery. Controls received normal saline solution as a placebo. The amount of intraoperative bleeding and surgical time were compared between the two groups. Results: The intervention group included 21 men (60%) and 14 women (40%), while the control group included 19 men (54.3%) and 16 women (45.7%). The mean ages of the participants were 55.46 ± 10.8 years and 58.06 ± 11.28 years in the intervention and control groups, respectively. A significant difference was observed between the two groups in the surgical time analysis (control group: 37.74 ± 9.52 minutes vs intervention: 26.03 ± 10.5 minutes; P < 0.001). Additionally, there was a significant difference in the bleeding volume between the intervention (70.66 ± 48.19 ml) and control (47.74 ± 60 ml) groups (P < 0.001). Conclusion: Intravenous tranexamic acid administration before the DCR procedure can successfully control bleeding during the surgery.

Effect of Prunus cerasus (Sour Cherry) on Nephrolithiasis in Children: The First Noninferiority Two-Arm Randomized Clinical Trial.

OBJECTIVE:  The present study evaluated the effect of Prunus cerasus (sour cherry) on children with nephrolithiasis. METHOD:  We conducted a randomized noninferiority controlled trial to evaluate the therapeutic efficacy of P. cerasus among children with nephrolithiasis. Subjects in the intervention group received 1.25 mL/kg of cherry concentrate once daily for 2 months, while the control group received 1 mL/kg Polycitra-K, which consists of 220 g citrate potassium and 68 g citric acid in 1000 mL sterile water. The major outcome was sonographically determined number and sizes of kidney stones, which were assessed before and after the trial. RESULTS:  Sixty-eight children completed the study. At trial onset, both groups were similar in baseline characteristics (P >.05). In within-group analysis, the number of stones significantly decreased in both groups (P <05). After 2 months, the number of nephrolithiasis was 1.55 ± 0.49 and 1.47 ± 0.67 in the control and intervention groups, respectively (P value=.56). The percentage of change in calculi number was 44.11 ± 11.12 and 38.14 ± 14.08 in the control and intervention groups, respectively (P value=.08). At the end of the study, the urine pH was 6.46 ± 0.99 and 6.14 ± 0.83 in the control and intervention groups, respectively (P value=.19). Urine calcium and uric acid concentrations were 32.00 ± 12.32 and 28.95 ± 10.96 mg/mm (P value=.68) and 24.11 ± 10.58 and 30.03 ± 11.39 mg/mm (P value=.012) in control and intervention groups, respectively. CONCLUSION:  Our clinical data supported the efficacy of sour cherry in the treatment of nephrolithiasis compared to Polycitra-K. Future randomized controlled trials are needed to confirm the present observation.

Neutrophil-to-lymphocyte ratio as a predictive biomarker for early diagnosis of depression: A narrative review.

Depression is a mood disorder that causes persistent feelings of sadness, hopelessness, loss of interest, and decreased energy. Early diagnosis of depression can improve its negative impacts and be effective in its treatment. Previous studies have indicated that inflammation plays an important role in the initiation and development of depression, hence, various inflammatory biomarkers have been investigated for early diagnosis of depression, the most popular of which are blood biomarkers. The Neutrophil to lymphocyte ratio (NLR) may be more informative in the early diagnosis of depression than other widely used markers, such as other leukocyte characteristics or interleukins. Considering the importance of early diagnosis of depression and the role of NLR in early diagnosis of depression, our paper reviews the literature on NLR as a diagnostic biomarker of depression, which may be effective in its treatment. Various studies have shown that elevated NLR is associated with depression, suggesting that NLR may be a valuable, reproducible, easily accessible, and cost-effective method for the evaluation of depression and it may be used in outpatient clinic settings. Closer follow-up can be performed for these patients who have higher NLR levels. However, it seems that further studies on larger samples, taking into account important confounding factors, and assessing them together with other inflammatory markers are necessary to draw some conclusive statements.

Comparison of low-dose ketamine to methadone for postoperative pain in opioid addicts: a randomized clinical trial.

BACKGROUND: Postoperative pain can lead to several complications. The effectiveness of different opioids in relieving pain after surgery has been widely studied. However, managing pain in patients with opioid addiction is still challenging. This study aimed to examine the impact of ketamine and methadone on postoperative pain in patients with addiction. METHODS: This was a non-inferiority randomized clinical trial. All included patients were monitored for morphine use, pain scores, and vital signs every 3 h. The intervention group received 0.5 mg/kg ketamine administered intravenously every 6 h. The control group received 5 mg of methadone intramuscularly every 8 h. The patient received intravenous morphine if their visual analog scale was above 3. All side effects in each group were recorded. RESULTS: Two hundred and twenty patients were included in this study. There were 127 men (57.7%) with an average age of 57.1 ± 19.5 and 93 women (42.3%) with an average age of 57.1 ± 21.0. There were no significant differences in demographic characteristics between the groups. There was no significant difference in the dose or frequency of morphine administration between groups. There was no significant difference between the groups in pain scores and vital signs at different time points. Drug side effects, including delirium and gastrointestinal symptoms, did not differ significantly between the methadone and ketamine groups. CONCLUSIONS: Our clinical data support the hypothesis that ketamine is not inferior to methadone in patients with addiction. Future randomize clinical trials are needed to confirm these observations.

Visual and Demographic Risk Factors for Falls and the Impact of Cataract Surgery in Elderly Patients.

Purpose: To evaluate the effect of cataract surgery and visual impairment and the associated risk factors on the frequency of falls among older adults in northeast Iran. Methods: This cross-sectional study, conducted between 2019 and 2020, analyzed the potential risk factors of falling in older adults over 50 years of age. To this end, 380 patients were randomly selected by convenience sampling and classified into two groups: those who had undergone cataract surgery in the last 12 months (surgery group) and those who had not (cataract group). The data were collected from the medical records and face-to-face interviews, and logistic regression was used to identify potential risk factors for falling. Results: The frequency of falls in the cataract and surgery groups was 18.9% and 11.6%, respectively. The mean decimal visual acuity of the dominant eye was significantly lower in the cataract group than in the surgery group (P < 0.001). There were no significant differences in the mean number of medications used, Charlson Comorbidity Index score, Instrumental Activities of Daily Living score, and 10-Meter Walk Test speed between the two groups. According to the results of backward logistic regression, taking more than four medications per day and slow gait speed were the most important factors influencing the frequency of falls in older adults. Conclusion: Logistic regression analysis indicated that undergoing cataract surgery is not a significant protective factor against falls. However, older adults in the surgery group experienced fewer falls than in the other group. Besides, the results suggest that taking more than four medications daily and having a slow gait speed are significant fall risk factors.

The Effect of Adding Sour Cherry Concentrate to The Usual Treatment of Attention Deficit Hyperactivity Disorder In 6 To 12 Years Old Children.

INTRODUCTION: This study aimed to evaluate the efficacy of sour cherry concentrate in symptoms of Attention Deficit Hyperactivity Disorder (ADHD). METHODS: In a randomized clinical trial, 70 children with ADHD referred to the psychiatric clinic of Ibn-e-Sina Hospital, Mashhad, Iran, in 2021 were selected. Patients were randomly divided into two groups. The intervention group received 75 ml of sour cherry concentrate twice daily in addition to the routine treatment for 2 weeks. The patients were evaluated using The Conner's Parent Rating Scale (CPRS) before and after the study by a psychiatry resident. RESULTS: Based on the findings, no significant differences were observed between the groups in change percent of Cognitive impairments (p = .317), Hyperactivity/impulsivity (p = .525), Oppositional (p = .986), and ADHD index (p = .451). Moreover, 28.6% and 31.4% of children with ADHD consuming the concentrate presented abdominal pain, and asthenia, respectively. CONCLUSION: The present study did not indicate a beneficial effect of sour cherry concentrate on symptoms of ADHD.

The clinical relationship between histamine-1 receptor antagonists and risk of cancer: a systematic review and meta-analysis.

BACKGROUND: A systematic research was performed to review the relationship between use of histamine-1 receptor antagonists and cancer risk. METHOD: Databases were searched up to December 2021. Case-control and cohort studies evaluating the relationship between use of histamine-1 receptor antagonists and risk of cancer were selected. The major outcome was cancer risk. Odds ratio (OR) with 95% confidence intervals (CIs) was calculated. Subgroup, cumulative, and sensitivity analysis and Egger test were performed. RESULTS: Five case-controls and one cohort study were included. According to cohort study, use of antihistamines were not associated with cancer risk (RR = 0.92, 95% CI = (0.78-1.07). In case-controls, the frequency of antihistamine use in cases and controls was 11.28% and 14.82% respectively which was associated with decreased cancer risk (p value = 0.02, OR = 0.93, 95%CI = (0.87, 0.99)). Sensitivity analysis showed a change in direction of pooled OR by omitting some studies. Sub-group analysis according to type of cancer showed a decrease in cancer risk in antihistamine users in glioma (p value = 0.03). CONCLUSION: Antihistamines might reduce the risk of certain cancers. More studies with defined background of allergy are needed which can clarify the relevancy of different types of cancer with anti-H1 receptors.

Serum level of vitamin A in febrile children with and without seizure: A comparative study.

Objective: The role of vitamins and antioxidants in the febrile seizure (FS) has recently become of interest. The role of Vitamin A in seizure is remained controversial. It may suppress or provoke the seizure. In present study, the serum vitamin A level in febrile patients was compared with febrile seizure children for the first time. Method: In a cross-sectional study, eighty children aged 6-60 months including 40 febrile children and 40 children with FS were included. Blood samples were obtained, and the serum level of vitamin A and other blood parameters were measured. Results: Patients were similar in demographic characteristics (p = 0.06 for age and p = 0.41 for sex). The serum vitamin A level was 0.19 (0.12, 0.25) and 0.22 (0.17, 0.29) milligram per liter (mg/L) in febrile and FS group respectively (p = 0.33). In children aged less than 24 months the serum vitamin A level in FS and febrile group was 0.22 ± 0.07 and 0.24 ± 0.12 mg/L respectively (p = 0.56). In children aged more than 24 months the serum vitamin A level in FS group was higher significantly in comparison with febrile group (0.25 ± 0.11 and 0.16 ± 0.07 mg/L respectively, p = 0.01). Conclusion: Serum vitamin A level was not different in febrile children with and without seizure. Surprisingly in children aged more than 24 months, the serum level of vitamin A was higher in FS group than in the febrile children. More studies are needed to confirm the present observation.

Epidemiology and Clinical Course of Pediatric Uveitis in a Tertiary Referral Center in Northeastern Iran.

PURPOSE: To describe the distribution, clinical findings, treatment, complications, and visual outcomes of pediatric uveitis at a tertiary referral ophthalmic center. METHODS: The medical records of all patients ≤18 years diagnosed with and managed as uveitis from August 2016 to August 2021 were reviewed retrospectively. RESULTS: Of the 97 patients, 52.6% were female, and the mean age at the onset was 10.5 ± 4.6 years (6 months to 18 years). Uveitis cases were predominantly anterior (33 [34%]), chronic (59 [60.8%]), bilateral (63 [64.9%]), and non-infectious (80 [82.5%]). A total of 36.1% (35 patients) of cases were idiopathic, and the most frequent systemic associations were juvenile idiopathic arthritis (JIA), 16 [16.5%]) and Behcet's disease (15 [15.5%]). Most patients (74 [76.3%]) experienced ocular complications, including vasculitis (29 [29.9%]), posterior synechiae (23 [23.7%]), and cataracts (22 [22.7%]). Patients with uveitis of all anatomic locations experienced an improvement in best-corrected visual acuity during the follow-up period (p < 0.01). CONCLUSION: The most prevalent systemic associations were JIA and Behcet's disease. Ocular Behcet is a common etiology of pediatric uveitis in northeastern Iran. A timely and appropriate treatment could result in satisfactory visual outcomes.

Pulmonary Invasive Fungal Disease: Ultrasound and Computed Tomography Scan Findings.

OBJECTIVE: The importance of ultrasound in diagnosing pulmonary invasive fungal diseases (IFD) has yet to be assessed. Thus, this study aimed to evaluate the frequency of sonographic findings in patients suspected of an invasive pulmonary fungal infection. MATERIAL AND METHODS: This prospective longitudinal study examined all patients with lung lesions in imaging modalities and suspected IFDs referred to Dr. Sheikh and Akbar pediatric hospitals from 2019 to 2022. Considered variables were the halo sign in the computed tomography (CT) scan; the target sign in the ultrasound and contrast-enhanced CT scan; the cavity; wedge-shaped consoli- dation; and pleuritis and extrapulmonary invasion to the chest wall or subdiaphragmatic invasion in both modalities. All patients who underwent lung CT scans and ultrasounds until the final diagnosis were followed up. The degree of agreement between ultrasound and CT scan findings and the sensitivity, specificity, and diagnostic accuracy of these signs were assessed. RESULTS: This study involved 40 patients with an average age of 7.16 ± 4.23 years. Acute leukemia was the commonest underlying dis- ease detected in 17 (42.5%) cases. The target sign in ultrasound (61.9%) and the halo sign in CT scan (71.4%) had the highest frequency among the variables in patients with IFD. Cohen's kappa coefficient agreement in both modalities was 0.5 for the cavity, with significant relation (P = .02). The Cohen's kappa was less than .17 for other findings (P > .05). The diagnostic criteria in the simultaneous examina- tion of the fungus target in ultrasound and halo in CT scan showed a sensitivity of 82.4% and specificity of 76.5%, respectively. CONCLUSION: Combining the characteristic findings of ultrasound and CT-scan provides a higher value in diagnosing pulmonary invasive fungal disease.

Clinical characteristics and management outcomes of acute retinal necrosis.

This study investigates patient's clinical characteristics and management outcomes of PCR-positive Acute Retinal Necrosis (ARN). The patient's clinical characteristics of the disease, and therapeutic approaches were assessed. Data from the medical records of 40 eyes of 40 patients were analyzed. The mean ± standard deviation (SD) of the age of the patients was 47.8 ± 14.1 years (16-84 years old). The median follow-up time was 160 days, with a range of 120-370 days. The mean ± SD of patients' primary and final BCVA was 1.24 ± 0.78 and 1.08 ± 0.86 LogMAR, respectively. The final BCVA increased significantly after the treatment in the last follow-up period in patients who did not undergo PPV (p = 0.029). Although, vision changes were not statistically significant in patients who underwent PPV (p = 0.549). 75% of our patients had a positive aqueous PCR for VZV, and the second most common causative agents were CMV and HSV (10% for each). Besides, rhegmatogenous retinal detachment (RRD) occurred in 25% of our patients. Our analysis showed that the presenting visual acuity and RRD occurrence are the significant prognostic factors for final blindness in ARN.

Efficacy and Safety of Angiotensin Receptor Blockers in Pediatric Patients (Aged 6 to 18) with Hypertension: A Systematic Review.

Angiotensin receptor blockers (ARBs) are commonly prescribed in pediatric hypertension because of the fundamental role of the renin-angiotensin-aldosterone system in the pathogenesis of hypertension. We, therefore, aimed to systematically review articles that investigated efficacy and safety of ARB agents in the pediatric population aged over six years. To do so, the databases of Web of Science, PubMed/MEDLINE, and Scopus were searched to conduct a systematic review by using the following keywords: ("angiotensin receptor blocker" OR "valsartan" OR "losartan") AND ("pediatric" OR "children" OR "child") AND ("high blood pressure" OR "hypertension"). Finally, 12 studies were included in our review, and we found that almost all of them supported the effectiveness and tolerability of different ARB agents. Candesartan cilexetil lowered blood pressure (BP), with a 9 mmHg decline in both systolic and diastolic BP, and proteinuria after four months of treatment. Valsartan and Losartan similarly were shown to be effective in lowering BP in a dose-dependent manner. Headache, dizziness, upper respiratory infection, and cough were the most reported side effects. However, almost all reviewed studies indicated that the safety profile was satisfactory. In conclusion, ARBs are beneficial and well-tolerated antihypertensive medications.  DOI: 10.52547/ijkd.7228.

Macular microvasculature in patients with thyroid-associated orbitopathy: a cross-sectional study.

PURPOSE: The aim of this study was to evaluate macular blood flow in patients with thyroid-associated orbitopathy (TAO) as compared to healthy subjects. The inflammatory nature of the disease, as well as the vascular congestion caused by the increase in the volume of orbital soft tissue and extraocular muscles, rationalize the assessment of retinal blood flow changes in these patients. METHODS: This is a cross-sectional study with the convenience sampling method. Macular flow density was assessed using optical coherence tomography angiography (OCTA) and compared between patients with TAO and healthy individuals. We also compared macular flow density in two subgroups of patients based on clinical activity score (CAS). RESULTS: Eighty-five cases, including 30 healthy individuals and 55 patients with TAO, participated. The foveal avascular zone (FAZ) area was significantly larger in the patient group than in the control. Patients with active TAO with CAS 3 or more had significantly larger FAZ areas than those with CAS less than 3 (p = 0.04). CONCLUSION: We showed that the FAZ area is larger in active TAO patients and can be considered a possible candidate feature for monitoring disease activity and thyroid-associated vasculopathy.