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BACKGROUND: This study examines the changes in segmental and global cervical sagittal parameters after single-level anterior cervical discectomy and fusion (ACDF) in patients with cervical radiculopathy or myelopathy. We also investigate whether these changes have any relation with postoperative pain and functional outcome of the patients. METHODS: Sixty patients (37 females and 23 males) with a mean age of 45.9 ± 9.5 years who were candidates of single-level ACDF due to cervical myelopathy or radiculopathy participated in the study. At baseline, 1 month, and 6 months after ACDF, outcomes of the study including sagittal balance parameters, pain intensity, and Neck Disability Index (NDI) were measured among the patients. Intensity of pain and neck disability were measured using the visual analog scale (VAS) and validated version of NDI, respectively. Using a standard lateral cervical radiography, the Cobb angle for occiput–C2, C1–C2, and C2–C7 as well as operation-level angle (OA; Cobb's angle at the level of discopathy), the thoracic inlet angle, and C7 and T1 slope angles were measured. RESULTS: The intensity of pain and neck disability of patients improved significantly during the follow up of the study comparing with baseline measurements (P < .001). There was a significant correlation between the increase of C2–C7 angle, C1–C2 angle, and OA and improvement in neck pain and NDI at 1- and 6-month follow ups. CONCLUSIONS: We found that changes at C2–C7 angle, C1–C2 angle, and OA have positive significant correlation with clinical outcome including pain improvement and decrease of disability in patients who undergo ACDF. LEVEL OF EVIDENCE: 3. CLINICAL RELEVANCE: The results of this study might be beneficial in selection of cervical cages with appropriate size during ACDF surgery, as our findinds showed that larger cages could lead to better functional outcome in patients.

Purpose: To describe the optical coherence tomography (OCT) findings of toxoplasmic retinochoroiditis at different stages of activity.Methods: Observational case series.Results: A total of 32 eyes of 31 patients were included; 43 sets of OCT were reviewed. A total of 14 lesions were classified as active, 13 as partially active, and 16 as inactive. All active lesions demonstrated increased retinal thickness and reflectivity with blurring of details of retinal layers. Choroidal granuloma was detected in eight (61.5%) and serous retinal detachment in nine (64%). In partially active lesions, sustained thickening and/or attachment of posterior hyaloid face with fine epiretinal membrane was the hallmark. Scarified lesions showed decreased retinal and choroidal thickness starting from the periphery. Characteristic signs for decreased activity of a lesion seen in majority of both partially active and inactive lesions were RPE changes and retina-RPE approximation. We called this unique feature 'hourglass configuration'.Conclusion: Features in OCT are helpful to specify and monitor the activity of toxoplasmic retinochoroiditis.

Purpose: Determine the risk of immunomodulatory therapy (IMT) for COVID-19 infection morbidity.Method: A telemedicine survey on patients of a referral uveitis clinic was performed. Signs of infection, habits, and hospitalizations during the 7 months of the COVID-19 pandemic prior to the study date were recorded. Suggestive findings in chest CT scan and/or positive RT-PCR were considered as confirmed COVID-19 infection while those with only suggestive symptoms were considered as suspected cases. Risk factors including sanitary measures and IMT were compared between patients with confirmed cases and patients without infection.Result: 694 patients were included. Eight patients were identified as confirmed cases and 22 patients as suspected cases of COVID-19 infection. Close contact with infected persons was the only significant risk factor for contracting COVID-19.Conclusion: Using IMT did not affect hospitalization and/or ICU admission and can thus be continued during the pandemic, provided that instructions for preventive measures are followed.

Fuchs uveitis (FU) is a chronic and often unilateral ocular inflammation and characteristic iris atrophic changes, other than heterochromia, are common in FU and are key to the correct diagnosis in many cases. With the advent of anterior segment optical coherence tomography (AS-OCT), some investigators attempted to quantitatively study these atrophic changes; mostly by introducing various methods to measure iris thickness in AS-OCT images. We aimed to present an automated method in an observational case series to measure the smoothness index (SI) of the iris surface in AS-OCT images. The ratio of the length of the straight line connecting the most peripheral and central points of the anterior iris border (in nasal and temporal sides) to the actual length of this border on AS-OCT images, was defined as SI. In a uveitis referral center, twenty-two eyes of 11 patients with unilateral Fuchs uveitis (FU) (7 female) and 22 eyes of 11 healthy control subjects underwent AS-OCT imaging. Image J and a newly developed MATLAB algorithm were used for manual and automated SI measurements, respectively. Agreement between manual and automated measurements was evaluated with Bland–Altman analysis and interclass correlation coefficient. The inter-eye difference of SI was compared between the FU group and the control group. Automated mean overall SI was 0.868 ± 0.037 and 0.840 ± 0.039 in FU and healthy fellow eyes, respectively (estimated mean difference = − 0.028, 95% CI [− 0.038, − 0.018], p p = 0.01). We concluded that the automated algorithm can rapidly and conveniently measure SI with results comparable to the manual method.

Glioblastoma multiforme (GBM) is the commonest primary malignant brain tumor and has a remarkably weak prognosis. According to the aggressive form of GBM, understanding the accurate molecular mechanism associated with GBM pathogenesis is essential. Growth differentiation factor 15 (GDF-15) belongs to transforming growth factor-β superfamily with important roles to control biological processes. It affects cancer growth and progression, drug resistance, and metastasis. It also can promote stemness in many cancers, and also can stress reactions control, bone generation, hematopoietic growth, adipose tissue performance, and body growth, and contributes to cardiovascular disorders. The role GDF-15 to develop and progress cancer is complicated and remains unclear. GDF-15 possesses tumor suppressor properties, as well as an oncogenic effect. GDF-15 antitumorigenic and protumorigenic impacts on tumor development are linked to the cancer type and stage. However, the GDF-15 signaling and mechanism have not yet been completely identified because of no recognized cognate receptor.

Surgical decompression, deformity correction, and instrumentation of the upper cervical spine are challenging problems in cervical kyphosis, especially in infants and pediatrics. According to patients' age, surgical exposure is difficult and selecting the appropriate instrument for rigid fixation is crucial. In this article, we present a case of 2 years old with cervical angular kyphosis, which was approached posteriorly at first. Through posterior approach, C3–C5 laminectomy with complete excision of spinous process was performed. Then, the patient's position was changed to supine and C3–C5 corpectomies were performed anteriorly with a longitudinal incision, and the thecal sac was decompressed. A titanium cage with appropriate size and graft was placed after possible deformity correction conducted with head traction and neck extension. Anterior fixation was performed with two, 2-mm T-shaped metacarpal plates with two screws in C2 and four screws in C6. The patient's position was changed to prone again, and posterior fixation was done with two metacarpal plates located on lateral masses. We showed that a novel technique in correction and fixation of cervical kyphosis in pediatric is using metacarpal plates while they are fixed to lateral masses.

Summary In a large‐scale study, 128176 non‐pregnant patients (228 studies) and 10000 pregnant patients (121 studies) confirmed COVID‐19 cases included in this Meta‐Analysis. The mean (confidence interval [CI]) of age and gestational age of admission (GA) in pregnant women was 33 (28–37) years old and 36 (34–37) weeks, respectively. Pregnant women show the same manifestations of COVID‐19 as non‐pregnant adult patients. Fever (pregnant: 75.5%; non‐pregnant: 74%) and cough (pregnant: 48.5%; non‐pregnant: 53.5%) are the most common symptoms in both groups followed by myalgia (26.5%) and chill (25%) in pregnant and dysgeusia (27%) and fatigue (26.5%) in non‐pregnant patients. Pregnant women are less probable to show cough (odds ratio [OR] 0.7; 95% CI 0.67–0.75), fatigue (OR: 0.58; CI: 0.54–0.61), sore throat (OR: 0.66; CI: 0.61–0.7), headache (OR: 0.55; CI: 0.55–0.58) and diarrhea (OR: 0.46; CI: 0.4–0.51) than non‐pregnant adult patients. The most common imaging found in pregnant women is ground‐glass opacity (57%) and in non‐pregnant patients is consolidation (76%). Pregnant women have higher proportion of leukocytosis (27% vs. 14%), thrombocytopenia (18% vs. 12.5%) and have lower proportion of raised C‐reactive protein (52% vs. 81%) compared with non‐pregnant patients. Leucopenia and lymphopenia are almost the same in both groups. The most common comorbidity in pregnant patients is diabetes (18%) and in non‐pregnant patients is hypertension (21%). Case fatality rate (CFR) of non‐pregnant hospitalized patients is 6.4% (4.4–8.5), and mortality due to all‐cause for pregnant patients is 11.3% (9.6–13.3). Regarding the complications of pregnancy, postpartum hemorrhage (54.5% [7–94]), caesarean delivery (48% [42–54]), preterm labor (25% [4–74]) and preterm birth (21% [12–34]) are in turn the most prevalent complications. Comparing the pregnancy outcomes show that caesarean delivery (OR: 3; CI: 2–5), low birth weight (LBW) (OR: 9; CI: 2.4–30) and preterm birth (OR: 2.5; CI: 1.5–3.5) are more probable in pregnant woman with COVID‐19 than pregnant women without COVID‐19. The most prevalent neonatal complications are neonatal intensive care unit admission (43% [2–96]), fetal distress (30% [12–58]) and LBW (25% [16–37]). The rate of vertical transmission is 5.3% (1.3–16), and the rate of positive SARS‐CoV‐2 test for neonates born to mothers with COVID‐19 is 8% (4–16). Overall, pregnant patients present with the similar clinical characteristics of COVID‐19 when compared with the general population, but they may be more asymptomatic. Higher odds of caesarean delivery, LBW and preterm birth among pregnant patients with COVID‐19 suggest a possible association between COVID‐19 infection and pregnancy complications. Low risk of vertical transmission is present, and SARS‐CoV‐2 can be detected in all conception products, particularly placenta and breast milk. Interpretations of these results should be done cautiously due to the heterogeneity between studies; however, we believe our findings can guide the prenatal and postnatal considerations for COVID‐19 pregnant patients.

To demonstrate the value of "smoothness index (SI)" as a novel tool for quantitative analysis of iris surface findings in unilateral Fuchs' uveitis (FU).Both phakic eyes from patients with unilateral FU as well as healthy control subjects underwent anterior segment optical coherence tomography (AS-OCT). The ImageJ software was used for calculating the SI.Forty eyes from 20 patients with unilateral FU and 40 eyes from 20 healthy subjects were enrolled. In FU eyes, mean overall SI (0.876 ± 0.030) was significantly higher than fellow control eyes (0.841 ± 0.041) (Iris "smoothness index" can be used to quantitatively assess iris surface smoothness and may facilitate the diagnosis of subtle iris atrophic changes in eyes affected by FU especially in the absence of heterochromia.

Purpose To study the relative contribution of major indications and geographic referral patterns for intravitreal bevacizumab injections in a tertiary hospital. Methods In this retrospective study, hospital electronic registry was used to categorize patients who had received intravitreal injections (IVIs) during the 2014-2016 period into different groups based on indications. Relative contribution of each indication and odds of being resident of provinces other than Tehran were determined. Results The most prevalent indications for IVI were pathologies related to diabetes mellitus (DM) followed by choroidal neovascularization (CNV)/age-related macular degeneration (AMD) and retinal venous occlusion (RVO)-related complications. From 38,043 patients, 61.8% were residents of Tehran province. Patients in the CNV/AMD group were the oldest. Patients from Tehran province were significantly older (62.44 ±11.42 (12-99)) than patients who were referred from other provinces (59.23 ±11.39 (11-102)) (p=< 0.001). The majority of patients in all indication categories were from Tehran province, except for patients with retinopathy of prematurity (ROP). Odds of being referred from outside Tehran province for the ROP group compared to the DM-related, CNV/AMD, RVO-related and miscellaneous groups were 3.32, 4.27, 3.13 and 2.83, respectively (p

Background and aims: The cardiac angiogenesis is one of the complications of diabetes. The oxidative stress occurs when there is an imbalance between the production of free radicals and antioxidant defense of the body. In diabetes mellitus, hyperglycemia induces increased oxidative stress through biological processes. Diabetes is also associated with reduced antioxidant defense by reducing glutathione, catalase, and superoxide dismutase. Rosa damascena Mill has antioxidant properties. This study aimed to investigate the effects of hydroalcoholic extract of R. damascena Mill on cardiac angiogenesis in diabetic rats. Methods: In this experimental study carried out in 2016, a total of 48 adult male Wistar rats (190-200 g) were randomly divided into 8 groups (n=6) including control, extracts (200, 400, and 1000 mg/kg), diabetic, and diabetic plus extracts (200, 400, and 1000 mg/kg). Diabetes was induced by intraperitoneal (i.p.) injection of streptozotocin (STZ) (50 mg/kg) and the rats were gavaged with different doses of extract for 30 days. At the end of the treatment, serum levels of vascular endothelial growth factor (VEGF) were determined by enzymelinked immunosorbent assay and the rat hearts were removed for immunohistochemistry study. Results: The treatment with hydroalcoholic extract of R. damascene Mill had no significant effect on cardiac capillary density [F (7, 40)=0.5, P>0.05] and the serum levels of VEGF [F (7, 40)=0.406, P>0.05]. However, there was no significant difference in blood glucose level in extract groups compared to control rats as well as diabetic plus extract groups compared to diabetic rats [F (7,40)=0.787, P>0.05]. Conclusion: According to our results, the hydroalcoholic extract of R. damascene Mill had no effect on cardiac angiogenesis in the normal and diabetic subjects. These findings were probably due to the insufficient amounts of effective ingredients, especially flavonoids, in this plant, or the duration of extract administration.

Background and Objectives: Considering the initiation of the Health Transformation Plan in the Ministry of Health and Medical Education in 2014, evaluation of this plan is of particular importance. The aim of this study was to investigate the performance indicators of the Emergency Department of Shahid Beheshti Hospital in Qom city (before and after the transformation plan). Methods: The study was carried out as a descriptive cross-sectional study in Shahid Beheshti Hospital of Qom city (year 2014). The statistical population consisted of the patients referring to the Emergency Department of the hospital, which was selected from the emergency and archived records and entered into the database. Four emergency department performance indicators, were selected and evaluated before and after the Health Development Plan. These indicators included the percentages of patients who were disposed under 6 hours, percentage of hospitalization of patients under 12 hours, unsuccessful cardiopulmonary resuscitation (CPR), and discharge with personal satisfaction. Data analysis was performed using the Chi square test. Results: Before and after the Health Transformation Plan, the percentage of patients who were disposed under 6 hours, reached from 86% to 78.5%, hospitalization rate of patients under 12 hours reached from 96% to 83%, discharge with personal satisfaction from 19% to 14%, and the percentage of unsuccessful cardiopulmonary resuscitation from 83% to 55.3%. The mean of these four indicators, was statistically significant 4 years after the implementation of the transformation plan (p

Background To assess the impact of brachytherapy on macular microvasculature utilizing optical coherence tomography angiography (OCTA) in treated choroidal melanoma. Methods In this retrospective observational case series, we reviewed the recorded data of the patients with unilateral extramacular choroidal melanoma treated with ruthenium − 106 (106Ru) plaque radiotherapy with a follow-up period of more than 6 months. Automatically measured OCTA retinal parameters were analysed after image processing. Results Thirty-one eyes of 31 patients with the mean age of 51.1 years were recruited. Six eyes had no radiation maculopathy (RM). From 25 eyes with RM, nine eyes (36%) revealed a burnout macular microvasculature with imperceptible vascular details. Twenty-one non-irradiated fellow eyes from the enrolled patients were considered as the control group. Foveal and optic disc radiation dose had the highest value to predict the burnout pattern (ROC, AUC: 0.763, 0.727). Superficial and deep foveal avascular zone (FAZ) were larger in irradiated eyes in comparison to non-irradiated fellow eyes (1629 μm2 vs. 428 μm2, P = 0.005; 1837 μm2 vs 268 μm2, P = 0.021; respectively). Foveal and parafoveal vascular area density (VAD) and vascular skeleton density (VSD) in both superficial and deep capillary plexus (SCP and DCP) were decreased in all irradiated eyes in comparison with non-irradiated fellow eyes (P P Conclusion The OCTA is a valuable tool for evaluating RM. Initial subclinical microvascular insult after 106Ru brachytherapy is more likely to occur in DCP. The deep FAZ area was identified as a more critical biomarker of BCVA than superficial FAZ in these patients.

Purpose: To study the correlation of OCT parameters including central subfield macular thickness (CSMT), peripapillary retinal thickness (PRT), and peripapillary retinal nerve fiber layer thickness (PNFLT) with fluorescein angiography (FA) in evaluation of inflammatory activity in Behcet’s retinal vasculitis.Method: In this case-series, concurrent FA and OCT were performed. A scoring system was devised for FA. PNFLT in 3.4-mm-diameter circle as well as PRT in doughnut shaped regions between the 1-mm- and 2.2-mm-diameter and between the 2.2-mm- and 3.45-mm-diameter circles was measured. The correlation of FA and OCT parameters was analyzed.Results: A total of 105 sets of FA from 28 eyes (15 patients) were reviewed. Four (26.6%) were female and mean age was 31.6±8.49 years. Each micron increases in CSMT, PRT2.2, PRT3.45, and PNFLT, caused a rise of 0.018 (95% CI:0.008 to 0.027, P

To study the correlation of OCT parameters including central subfield macular thickness (CSMT), peripapillary retinal thickness (PRT), and peripapillary retinal nerve fiber layer thickness (PNFLT) with fluorescein angiography (FA) in evaluation of inflammatory activity in Behcet’s retinal vasculitis. In this case-series, concurrent FA and OCT were performed. A scoring system was devised for FA. PNFLT in 3.4-mm-diameter circle as well as PRT in doughnut shaped regions between the 1-mm- and 2.2-mm-diameter and between the 2.2-mm- and 3.45-mm-diameter circles was measured. The correlation of FA and OCT parameters was analyzed. A total of 105 sets of FA from 28 eyes (15 patients) were reviewed. Four (26.6%) were female and mean age was 31.6 ± 8.49 years. Each micron increase in CSMT, PRT2.2, PRT3.45, and PNFLT, caused a rise of 0.018 (95% CI 0.008–0.027, P

As a health problem, obesity has several risk factors; it has been suggested that human adenovirus type 36 (HAdV-36) infections may possibly be associated with obesity. This updated meta-analysis was designed and conducted with an emphasis on articles published from 2015 to 2020. The PubMed, Web of Science, and Scopus databases were searched up to 1 December 2020. Overall, pooled prevalence and odds ratio of antibodies against HAdV-36 in people with obesity and controls was assessed among different ages. Case-control and cohort studies were included in the analysis. The overall prevalence of HAdV-36 infection in obese population was 31% (CI: 0.24%-0.38%) which was 32% in cases and 27% in controls, respectively; a significant association was found between the cases and the controls (OR, 1.84; 95% CI, 1.39-2.43), especially in children younger than 18 years of age (OR, 2.44; 95% CI, 1.85-3.22). A significant association between adenovirus infection and obesity was found, especially in adolescents.

Background. The aim is to report an atypical presentation of ocular toxoplasmosis which led to the diagnosis of Acquired Immunodeficiency Syndrome (AIDS). Case Report. The 38-year-old woman was referred with metamorphopsia and reduced vision in the right eye over the past 3 weeks. Slit-lamp examination revealed granulomatous keratic precipitates (KPs), 2+ cells in the anterior chamber, and posterior synechiae. Fundus examination was remarkable for a white patch surrounding a scar, inferonasal to the optic disc with fibrous bands emanating from the lesion, and the retina around this region was detached with considerable extension towards the periphery, while no breaks could be appreciated. She mentioned anorexia and losing 10 kg in the past three months, and signs of anemia like paleness of face skin, bed nails, and bilateral angular cheilitis were observed on systemic evaluation. The results of the patient’s complete blood count revealed anemia and leukopenia and CD4 lymphocytes: 79 cells/μL. Enzyme-linked immunosorbent assays (ELISA) for HIV antibodies came back positive which was later confirmed with the Western blot test. Brain magnetic resonance imaging (MRI) showed multiple ring-enhancing lesions in both cerebral cortices. The patient underwent antitoxoplasmosis and anti-HIV treatment and serous retinal detachment completely resolved. Conclusion. This report highlights the fact that sometimes, the eyes are the site of the first presentation of a systemic life-threatening condition and emphasizes the role of ophthalmologists in such cases. In cases of atypical presentation, appropriate laboratory tests and CNS imaging should be requested. Systemic treatment with antitoxoplasmosis regimens and highly active antiretroviral therapy (HAART) is mandatory in AIDS patients with ocular toxoplasmosis.

Purpose: To present the success rate of nonsurgical management of full-thickness inflammatory macular hole (IMH)Method: Retrospective case series of five patients with IMH.Result: Five eyes from five patients with IMH enrolled in the current case series. All five eyes had successful closure with corticosteroid in the form of topical, periocular, or intravitreal injections. Systemic immunomodulatory treatment was employed for two patients, in addition to local therapy. For local therapy, one patient received topical eye drops, subtenon injection of corticosteroid, and intravitreal injection of combination of corticosteroid and anti-VEGF was performed in two patients. The closed macular hole reopened in one patient after two years, which required pars plana vitrectomy and anatomical and visual success achieved.Conclusion: Inflammatory macular holes can be closed with non-surgical interventions, although reopening may occur which requires surgery.

To describe a novel association of enhanced S-cone syndrome (ESCS) with macular retinal neovascularization and severe retinal vasculitis. Clinical examination, spectral domain optical coherence tomography, fluorescein angiography, fundus autofluorescence, infrared reflectance and electroretinography were used to study a 25-year-old male with a history of night blindness from early childhood and recent accelerated visual loss in right eye. Pigmented lesions were observed along the arcades without peripheral retinal involvement. Intraretinal cystoid spaces, retinal neovascularization of posterior pole and severe peripheral and posterior retinal vasculitis were found on clinical examination and multimodal imaging. Based on characteristic clinical and electroretinographic findings, a diagnosis of ESCS was made. This case highlights novel associations of retinal neovascularization and vasculitis with ESCS.

Purpose: The present study aimed to evaluate the frequency and risk factors of retinopathy of prematurity (ROP) among Iranian infants. Methods: A retrospective cohort study was conducted on infants who had undergone screening for ROP at Farabi Eye Hospital, between March 2016 and March 2017. Data were analyzed based on the presence of extreme prematurity (gestational age ≤ 28 weeks), extremely low-birth-weight ( ≤ 1000 g), and multiple-gestation (MG) infants. Results: The prevalence of ROP was 27.28% ( n = 543) among all screened infants, 74.4% for extremely preterm (EP) infants, 77.5% for extremely low birth weight (ELBW) babies, and 27.25% for infants from MG pregnancies. On multivariate analysis, gestational age, birth weight, and history of transfusion ( P < 0.0001, P < 0.0001, and P = 0.04, respectively) were found to be significantly associated with ROP. More advanced stages of ROP ( P < 0.0001) were observed in EP and ELBW infants. Birth weight ( P = 0.088), history of transfusion ( P = 0.066), and intubation ( P = 0.053) were not associated with increased risk of ROP in EP infants, while gestational age ( P = 0.037) and history of transfusion ( P = 0.040) were significant risk factors for ROP in ELBW infants. Gestational age (P < 0.001) and birth weight ( P = 0.001) were significantly associated with ROP in infants from MG pregnancies in multivariate analysis. Conclusion: ROP remains a commonly encountered disease, especially in ELBW and EP infants. The history of transfusion may have a role in stratifying the risk for ROP and guiding future screening guidelines.

[EN] The very low-density lipoprotein receptor (VLDLR) plays an important function in the control of serum triglycerides and in the development of non-alcoholic fatty liver disease (NAFLD). In this study, we investigated the role of peroxisome proliferator-activated receptor (PPAR)β/δ activation in hepatic VLDLR regulation. Treatment of mice fed a high-fat diet with the PPARβ/δ agonist GW501516 increased the hepatic expression of Vldlr. Similarly, exposure of human Huh-7 hepatocytes to GW501516 increased the expression of VLDLR and triglyceride accumulation, the latter being prevented by VLDLR knockdown. Finally, treatment with another PPARβ/δ agonist increased VLDLR levels in the liver of wild-type mice, but not PPARβ/δ-deficient mice, confirming the regulation of hepatic VLDLR by this nuclear receptor. Our results suggest that upregulation of hepatic VLDLR by PPARβ/δ agonists might contribute to the hypolipidemic effect of these drugs by increasing lipoprotein delivery to the liver. Overall, these findings provide new effects by which PPARβ/δ regulate VLDLR levels and may influence serum triglyceride levels and NAFLD development., [ES] El receptor de las lipoproteínas de muy baja densidad (VLDLR) desempeña una función muy importante en el control de los niveles de triglicéridos séricos y en el desarrollo de la enfermedad del hígado graso no alcohólico (EHGNA). En este estudio hemos investigado el papel de la activación del receptor activado por los proliferadores peroxisómicos (PPAR)β/δ en la regulación hepática del VLDLR. El tratamiento de ratones alimentados con una dieta rica en grasas con el agonista PPARβ/δ GW501516 aumentó la expresión hepática de Vldlr. Asimismo, la exposición de hepatocitos humanos Huh-7 a GW501516 aumentó la expresión de VLDLR y la acumulación de triglicéridos, siendo este ultimo aumento evitado por el knockdown de VLDLR. Finalmente, el tratamiento con otro agonista PPARβ/δ incrementó los niveles de VLDLR en el hígado de ratones wild-type, pero no en el de ratones deficientes en PPARβ/δ, confirmando la regulación del VLDLR hepático por este receptor. En conjunto, nuestros resultados proporcionan un nuevo efecto por el que PPARβ/δ regula los niveles de VLDLR y puede influenciar los niveles de triglicéridos séricos así como el desarrollo de la EHGNA.

To evaluate B1 and RE genes as targets to detect Toxoplasma gondii, nested PCR is used in blood samples of patients with ocular toxoplasmosis. Following the measurement of IgG and IgM antibodies using indirect ELISA, IgG avidity and assessment of blood samples by nested PCR, the agreement between various test results was studied. From 117 patients, 77 (65.81%) were found to be positive for IgG anti-Toxoplasma antibody, 12 cases were positive for both IgG and IgM, and 1 patient was positive for IgM only. The detection limit for the RE-nested PCR assay was one T. gondii tachyzoite, whereas the limit for B1-nested PCR was five tachyzoites. Nested PCR results showed higher agreement with IgM test results than IgG test results. The results of this study showed that nested PCR of peripheral blood is a useful and non-invasive method for detection of T. gondii in patients with OT, especially in case of recently acquired infections, and RE targeted assay is more sensitive than B1 targeted assay for this purpose.

Introduction and objective Toxocariasis, predominantly caused by Toxocara canis , is a common zoonotic parasitosis worldwide. Toxocara infection is a cause of vision impairment and blindness. The presented study investigates the frequency of antibodies against Toxocara among uveitis patients and the epidemiological factors associated with disease. Material and methods Fifty-four patients with uveitis and 59 healthy subjects were studied. Anti- Toxocara antibodies status was determined in all serum samples using enzyme linked immunosorbent assay (ELISA), and seropositive samples analyzed by Western blot (WB) technique. Results The frequency of Toxocara canis infection was found to be significantly higher in uveitis patients, compared to healthy controls by the use of ELISA test, being 14.8% and 1.7%, respectively. From 8 seropositive samples, 5 (62.5%) patients exhibited Toxocara immunoglobulin G (IgG) antibodies in response to Western blot, whereas in the control group, none were detected positive by Western blot. No significant difference was found between pet owners, nor between different places of residence. The seroprevalence to Toxocara among uveitis patients was significantly related to gender, age and medical diagnosis. The highest prevalence was found in patients with posterior uveitis (27.8%). Conclusions Anti- Toxocara antibody titers are associated with the risk of vision impairment -uveitis. The risk factor associated with Toxocara exposure identified in this study warrants further investigation.

Introduction: This study aimed to determine the effect of wet-cupping on pain intensity in patients with migraines. Method: 132 patients were diagnosed with migraines. Pain intensity was evaluated based on the visual analogue scale. After homogenizing the data, patients were randomly divided into two (wet-cupping and control) groups. Paired t-test, Kruskal-Wallis and Mann-Whitney tests were used to analyze the data. Results: The mean of pain intensity of wetcupping (7.61+/-1.29) and control (7.22+/-1.21) before the intervention showed no significant difference (p=0.401). There was a significant difference between the mean of pain relief intensity of wet-cupping (2.4+/-1.9) and control (0.6+/-0.8) groups before and after interventions (p

Angiomyolipoma (AML) is a rare, benign tumor composed of thick-wall blood vessels, smooth muscle component and mature adispose tissue. Differentiation from other benign and malignant mesenchymal lesions of oral cavity depends on recognition of these three histologic components, and immunohistochemical (IHC) techniques are also helpful. This tumor arise from perivascular epithelioid cells (PEComas) and kidneys followed by liver are the main locations of this soft tissue tumor. AMLs are rarely found in oral cavity and few case reports of oral AML have been reported in the literature. We report the first case of concurrent occurrence of AML of the tongue and peripheral giant cell granuloma of the gingiva in a 59-year-old patient. Clinically it was presented as a painless nodular mass with a smooth surface on the dorsal of the tongue. Based on histopathologic features and IHC staining the diagnosis of oral AML was done. The other lesion was a small sessile mass in interdental papillae of the lower incisors and microscopic examination showed the histologic features of a peripheral giant cell granuloma. Concurrent occurrence of PGCG which is a reactive mucosal hyperplasia and AML in our patient, could show the probable role of local trauma in the pathogenesis of these lesions.

Background: The aim is to report an atypical presentation of ocular toxoplasmosis which led to the diagnosis of Acquired Immunodeficiency Syndrome (AIDS). Case report: The 38-year-old woman was referred with metamorphopsia and reduced vision in the right eye in the past 3 weeks. Slit-lamp examination revealed granulomatous keratic precipitates (KPs), 2+ cells in the anterior chamber, and posterior synechiae. Fundus examination was remarkable for a white patch surrounding a scar, inferonasal to the optic disc with fibrous bands were emanating from the lesion and the retina around this region was detached with considerable extension towards periphery, while no breaks could be appreciated. She mentioned anorexia and losing 10 kg in the past three months and bilateral angular cheilitis was observed on systemic evaluation. The results of the patient's complete blood count revealed bicytopenia and CD4 lymphocytes: 79 cells/µl. Enzyme-linked immunosorbent assays (ELISA) for HIV antibodies came back positive which was later confirmed with the Western-blot test. Brain Magnetic Resonance Imaging (MRI) showed multiple ring-enhancing lesions in both cerebral cortices. Patient underwent Anti-Toxoplasmosis and Anti-HIV treatment and serous retinal detachment was completely resolved. Conclusion: This report highlights the fact that sometimes the eyes are the site of the first presentation of a systemic life-threatening condition and emphasizes the role of ophthalmologists in such cases. In cases of atypical presentation, appropriate laboratory tests and CNS imaging should be requested. Systemic treatment with anti-toxoplasmosis regimens and HAART is mandatory in AIDs patients with ocular toxoplasmosis.

BackgroundTreatment of early-onset scoliosis (EOS) is still a challenge to patients, families, and surgeons. Previous studies have indicated that EOS patients are at high risk for complications following growth-friendly surgery. This study was performed to evaluate the results and complications of all-pedicle screw dual growing rod instrumentation in the treatment of EOS.MethodsIn an IRB-approved retrospective study, we searched the electronic medical records of our institution for all patients who underwent posterior spinal instrumentation for scoliosis between March 2014 and March 2017. Patients under the age of 10 at the time of surgery who were treated with a growth-friendly technique were then selected. Patients with incomplete records and less than 2 years of follow-up were excluded. Charts, operative notes, clinic visits, and radiographs were extracted. Radiographs were reviewed, and the main curve Cobb angle, thoracic kyphosis, pelvic tilt, pelvic incidence, sacral slope, and proximal junctional angles were measured. We specifically looked for any intra-operative or post-operative complications. Statistical analysis was performed to determine the risk factors of complications.ResultsA total of 42 patients with a mean age of 4.8 ± 2.1 years (range, 1.5–8 years) were included in the final analysis. Patients were followed for a median of 34 months (range, 24–55). The major curve was corrected from a mean of 42.9° ± 10.7° to 28.8° ± 9.6° at the latest follow-up. Proximal junctional angles and thoracic kyphosis increased significantly during the follow-up period (bothPvalues < 0.001). A total of 7 complications (17%) were observed. Four patients (10%) developed superficial surgical site infections, all of which resolved with antibiotics and one round of surgical debridement. Three cases (7%) of proximal junctional kyphosis (PJK) were encountered during the study period, none of which required revision surgery. Pre-operative thoracic kyphosis was the only significant risk factor for the development of PJK.ConclusionsOur findings suggest that in settings without access to magnetically controlled growing rods, dual growing rods with all-pedicle screw instrumentation is still a viable treatment strategy with comparable results and complications. The most common complications are infection and PJK, with the latter being associated with a larger pre-operative thoracic kyphosis.

Highlights • COVID-19 disease, the recently public health crises in the world, is emerged by spreading the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). • This virus can produce from weak to severe respiratory diseases including acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome (MODS), pneumonia and even death in patients. • Developing effective therapy is an urgent requirement to battle the SARS-CoV-2 virus and prevent further pandemic. • Interferons (IFNs) have shown to be crucial in fighting with COVID-19 disease and can be a suitable candidate in treatment of these patients. • Combination therapy can be more effective than monotherapy to cure this disease., The recently public health crises in the world is emerged by spreading the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) also named COVID-19. The virus is originated in bats and transported to humans via undefined intermediate animals. This virus can produce from weak to severe respiratory diseases including acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome (MODS), pneumonia and even death in patients. The COVID-19 disease is distributed by inhalation via contaminated droplets or contact with infected environment. The incubation time is from 2 to 14 day and the symptoms are typically fever, sore throat, cough, malaise, fatigue, breathlessness among others. It needs to be considered that many infected people are asymptomatic. Developing various immunological and virological methods to diagnose this disease is supported by several laboratories. Treatment is principally supportive; however, there are several agents that are using in treating of COVID-19 patients. Interferons (IFNs) have shown to be crucial in fighting with COVID-19 disease and can be a suitable candidate in treatment of these patients. Combination therapy can be more effective than monotherapy to cure this disease. Prevention necessitates to be performed by isolation of suspected people and home quarantine as well as taking care to infected people with mild or strict disease at hospitals. As the outbreak of SARS-CoV-2 has accelerated, developing effective therapy is an urgent requirement to battle the virus and prevent further pandemic. In this manuscript we reviewed available information about SARS-CoV-2 and probable therapies for COVID-19 patients.

The article's abstract is not available.

Background: The fundamental problems with the personality disorders diagnostic system in DSM-IV led to the revision of the DSM approach and proposition of a dimensional model for DSM-5. The DSM-5 Personality and personality disorders workgroup developed the personality inventory for DSM-5 (PID-5) to assess the pathological personality traits within this new model. Objectives: The purpose of this study was to investigate the psychometric properties of PID-5 in psychiatric patients. Methods: In a cross-sectional study, the Persian translation of the PID-5 was administered to 400 psychiatric patients admitted to the Roozbeh Hospital. After data collection, the reliability of the inventory was investigated using internal consistency and test-retest methods. In addition, confirmatory factor analysis and convergent validity methods were used to evaluate the validity of the scale. Results: Adequate internal consistency coefficients were obtained for domains and facets. In addition, the test-retest coefficients (up to 0.70) suggested scale stability. Confirmatory factor analysis supported the original five-factor model of the inventory. The convergent validity of the inventory with the TCI-R scale was appropriate. Conclusions: The results of the study supported the psychometric properties of the Persian version of PID-5 in psychiatric populations.

The occurrence of cognitive dysfunctions and anxiety and mood disorders has been shown to be higher in migraine patients. Nitric Oxide (NO) is a significant neurotransmitter in the pathophysiology of migraine, anxiety and neurodegenerative disorders. Therefore, the present study was conducted to evaluate the role of NO system in migraine-induced memory impairment and anxiety like behaviors. Nitroglycerin (NTG) was administered to the animals as an animal model of migraine and pretreatment with L-Arginine, L-NAME and saline were implemented to evaluate the role of NO system in possible cognitive impairments in animal model of migraine. Avoidance learning and memory performance, object recognition memory, anxiety-like behavior and motor activity were assessed using a shuttle box apparatus, novel object recognition, elevated plus-maze, and open field tests respectively. The data showed that the injection of nitroglycerin disturbs learning and memory and elicit anxiety like behavior in the animals. L-NAME administration suppressed the observed effect of nitroglycerin on memory and anxiety. Overall, the results indicated that nitric oxide system is implicated in memory impairments and anxiety like behavior in an animal model of migraine., Nitric oxide; Migraine; Cognitive function; Anxiety; Neuroscience; Cell biology; Physiology; Neurology; Psychiatry; Psychology

Background Glucagon-like peptide-1 (GLP-1), a gut-derived incretin hormone, plays a pivotal role in glucose-induced insulin secretion. Currently, the role of incretin hormones in the pathogenesis of cirrhosis is not clearly defined. This study aimed to investigate circulating levels of GLP-1 in liver cirrhosis and its association with the severity of liver disease. Methods A total of 80 participants including 39 patients with a definite diagnosis of liver cirrhosis and 41 healthy controls recruited in this cross-sectional study. Circulating levels of GLP-1 were determined using the ELISA method. The severity of liver cirrhosis was assessed according to the Child-Pugh, MELD (i), MELD-Na, MELD New, and UK end-stage liver disease score (UKELD) criteria. Results The mean age of patients and healthy subjects was 42.51 ± 12.80 and 42.07 ± 10.92 years, respectively (p value = .869). The mean MELD (i), MELD-Na, MELD New, UKELD, and Child-Pugh scores were 14.36 ± 4.26, 15.26 ± 4.81, 14.74 ± 4.66, 52.33 ± 3.82, and 7.28 ± 1.50, respectively. In this study, circulating levels of GLP-1 were statistically lower in cirrhotic patients compared with healthy controls (95.26 ± 17.15 vs 111.84 ± 38.14 pg/mL; p value = .017). Conclusion Larger prospective studies are needed to explore the incretin effect in cirrhosis patients compared with healthy individuals.

We read with great interest an article from Li colleagues describing ¨The Neuroinvasive Potential of SARS‐CoV2 May Play a Role in the Respiratory Failure of COVID‐19 Patients¨. Here we describe subarachnoid hemorrhage (SAH) as a severe neurological manifestation associated with pediatric COVID‐19. This article is protected by copyright. All rights reserved.

Background Deficiency of mitochondrial sirtuin 3 (SIRT3), a NAD+-dependent protein deacetylase that maintains redox status and lipid homeostasis, contributes to hepatic steatosis. In this study, we investigated additional mechanisms that might play a role in aggravating hepatic steatosis in Sirt3-deficient mice fed a high-fat diet (HFD). Methods Studies were conducted in wild-type (WT) and Sirt3−/− mice fed a standard diet or a HFD and in SIRT3-knockdown human Huh-7 hepatoma cells. Results Sirt3−/− mice fed a HFD presented exacerbated hepatic steatosis that was accompanied by decreased expression and DNA-binding activity of peroxisome proliferator-activated receptor (PPAR) α and of several of its target genes involved in fatty acid oxidation, compared to WT mice fed the HFD. Interestingly, Sirt3 deficiency in liver and its knockdown in Huh-7 cells resulted in upregulation of the nuclear levels of LIPIN1, a PPARα co-activator, and of the protein that controls its levels and localization, hypoxia-inducible factor 1α (HIF-1α). These changes were prevented by lipid exposure through a mechanism that might involve a decrease in succinate levels. Finally, Sirt3−/− mice fed the HFD showed increased levels of some proteins involved in lipid uptake, such as CD36 and the VLDL receptor. The upregulation in CD36 was confirmed in Huh-7 cells treated with a SIRT3 inhibitor or transfected with SIRT3 siRNA and incubated with palmitate, an effect that was prevented by the Nrf2 inhibitor ML385. Conclusion These findings demonstrate new mechanisms by which Sirt3 deficiency contributes to hepatic steatosis. Graphical abstract

Over the past decade, the growing interest in targeted lung cancer therapy has guided researchers toward the cutting edge of controlled drug delivery, particularly magnetic particle targeting. Targeting of tissues by magnetic particles has tackled several limitations of traditional drug delivery methods for both cancer detection (e.g., using magnetic resonance imaging) and therapy. Delivery of magnetic particles offers the key advantage of high efficiency in the local deposition of drugs in the target tissue with the least harmful effect on other healthy tissues. This review first overviews clinical aspects of lung morphology and pathogenesis as well as clinical features of lung cancer. It is followed by reviewing the advances in using magnetic particles for diagnosis and therapy of lung cancers: (i) a combination of magnetic particle targeting with MRI imaging for diagnosis and screening of lung cancers, (ii) magnetic drug targeting (MDT) through either intravenous injection and pulmonary delivery for lung cancer therapy, and (iii) computational simulations that models new and effective approaches for magnetic particle drug delivery to the lung, all supporting improved lung cancer treatment. The review further discusses future opportunities to improve the clinical performance of MDT for diagnosis and treatment of lung cancer and highlights clinical therapy application of the MDT as a new horizon to cure with minimal side effects a wide variety of lung diseases and possibly other acute respiratory syndromes (COVID-19, MERS, and SARS)., Graphical Abstract Unlabelled Image, Highlights • The physics and utility of magnetic particle targeting for diagnosis of lung cancer are presented. • The present magnetic drug targeting and delivery systems, including intravenous injection and pulmonary delivery, for lung cancer therapy are reviewed. • The technical advantages and practical drawbacks of various magnetic drug delivery methods are highlighted. • The future pespective on improved magnetic drug delivery and targeting to lungs is presented.

Interferons (IFNs) are a group of signaling cytokines, secreted by host cells to induce protection against various disorders. IFNs can directly impact on tumor cells or indirectly induce the immune system to protect host cells. The expression levels of IFNs and its functions of are excellently modulated in a way to protect host cells from probable toxicities caused by extreme responses. The efficacy of anticancer therapies is correlated to IFNs signaling. Although IFN signaling is involved in induction of antitumor responses, chronic stimulation of the IFN signaling pathway can induce resistance to various antineoplasm therapies. Hence, IFNs are expressed by both cancer and immune cells, and modulate their biological function. Understanding this mechanism of action might be a key target of combination therapies.

Purpose: To report the clinical spectrum, viral etiologies, therapeutic interventions, timing of rhegmatogenous retinal detachments (RRD), and visual outcomes in acute retinal necrosis (ARN) syndrome in a series of polymerase chain reaction (PCR)-positive eyes. Methods: From January 2010 to January 2017, consecutive patients with the clinical diagnosis of ARN and a positive aqueous viral PCR were included in this observational, retrospective study. Results: Nineteen eyes found to have a clinical diagnosis of ARN, of which 18 (94.7%) had a positive viral PCR. ARN was unilateral, except in one patient. None of the fellow eyes manifested ARN during follow-up. Varicella-zoster virus (VZV) was detected in 78.0% of ARN eyes. 61.1% of eyes experienced RRD. The median time for the occurrence of RRD was 12 weeks (range: 6–25 weeks) after disease onset. No correlation was found between the etiologic viral agent (VZV vs non-VZV; p = 1.000), extent of retinitis (1–2 quadrant vs 3–4 quadrants; p = 0.326), administration of intravitreal ganciclovir (injected vs not injected; p = 0.332), application of prophylactic laser retinopexy (applied vs not applied; p = 0.326), and subsequent occurrence of RRD. At a 2-year follow-up, visual impairment (VA ⩽ 20/200) and severe visual loss (VA ⩽ light perception) were significantly higher in those complicated by RRD compared to non-RRD eyes (81.8% vs 28.6%; p = 0.047, and 45.4% vs 0.0%; p = 0.004, respectively). Conclusion: Aqueous PCR results are highly consistent with the clinical diagnosis of ARN. Regardless of the method of management, the rate of RRD is high and is associated with a poor visual outcome.

Background: Osteoid osteoma (OO) is a benign osteoblastic neoplasm, mostly occurring in long bones of lower extremity. Its manifestation in unusual locations can be a diagnostic challenge and distressing for patients. OO in carpal bones is uncommon; its occurrence in triquetrum is even more so. Case Presentation: This study reports on a nineteen-year-old female with history of wrist pain for 4 years. She had sustained trauma to the same wrist before commencing of pain. Patient's pain was unresponsive to conservative treatments. Her routine x-rays were mostly interpreted as normal and obtaining further imaging helped us in diagnosis of OO of triquetrum. Surgical resection of the nidus was performed. Conclusions: Manifestation of OO in small carpal bones may not be typical; identifying the lesion or nidus could be challenging. Whatever unusual the location or presentation of such lesions may be, obtaining advanced imaging can be of significant help; therefore, we suggest clinicians to have low threshold in ordering advanced imaging specifically in patients suffering from chronic pain. Also, persistent history of nocturnal pain is a sign which is worth attention.

Here, we report a case of otherwise typical Fuchs uveitis (FU) who presented with atypical keratic precipitates (KPs). A 38 year-old man presented with decreased vision in the right eye. Best corre...

Background: Acromion fractures are rare injuries that may occur because of shoulder trauma. This may be associated with distal clavicle fractures, which can be an indication for surgery. There are several methods, which are used for fixation of this type of fractures. Case Presentation: In this paper, we presented a 34 years old man with acromion fracture in contribution with acromioclavicular (AC) joint dislocation. We applied a new method for fixation of this fracture. The fracture was fixed by 2 screws and AC Joint was fixed by a 4-hole hook plate. Conclusions: It is important to be aware of acromial fracture to not miss them and also for early management, so that early recovery and satisfactory results can be gained

Background The authors report two cases of the scleral buckles intrusion and erosion that presented many years after primary surgery with vitreous haemorrhage in one of them. Although the erosion/intrusion of a silicone scleral buckle (SB) is rare, it may have serious consequences and optimal management can be challenging. Therefore, this diagnosis should be considered if attributable signs and symptoms including vitreous haemorrhage occurred after scleral buckling. The authors briefly review the literature on clinical presentation and management of the episcleral silicone buckling erosion and intrusion. Case presentation Case 1: A 48-year-old woman with a history of scleral buckling for an inferior rhegmatogenous retinal detachment presented with visual loss in her right eye. A vitreous haemorrhage was observed. After Close observation, Partial resolution of haemorrhage revealed an intruded sponge segment in inferior vitreous cavity. Case 2: A 26-year-old man was referred for retinal evaluation. Twenty years earlier, he had undergone lensectomy for bilateral childhood cataract. Ten years ago, he had developed an aphakic RRD in the left eye. The detachment was managed with pars plana deep vitrectomy, endolaser, an encircling silicone band, and silicone oil injection. On examination an eroded band was noted. Conclusion Although the erosion/intrusion of a silicone episcleral buckle is rare, it may have serious consequences and optimal management can be challenging. Unnecessarily destructive techniques may predispose the eye to this complication and should be avoided. Patients who have a history of SB need lifelong follow-up and this diagnosis should be considered if attributable signs and symptoms occurred.

Nonalcoholic steatohepatitis (NASH), the severe stage of nonalcoholic fatty liver disease (NAFLD), is defined as the presence of hepatic steatosis with inflammation, hepatocyte injury, and different degrees of fibrosis. Although NASH affects 2–5% of the global population, no drug has been specifically approved to treat the disease. Fibroblast growth factor 21 (FGF21) and its analogs have emerged as a potential new therapeutic strategy for the treatment of NASH. In fact, FGF21 deficiency favors the development of steatosis, inflammation, hepatocyte damage, and fibrosis in the liver, whereas administration of FGF21 analogs ameliorates NASH by attenuating these processes. We review mechanistic insights into the beneficial and potential side effects of therapeutic approaches targeting FGF21 for the treatment of NASH.

Background: To describe the protocol for developing a national inherited retinal disease (IRD) registry in Iran and present its initial report. Methods: This community-based participatory research was approved by the Ministry of Health and Medical Education of Iran in 2016. To provide the minimum data set (MDS), several focus group meetings were held. The final MDS was handed over to an engineering team to develop a web-based software. In the pilot phase, the software was set up in two referral centers in Iran. Final IRD diagnosis was made based on clinical manifestations and genetic findings. Ultimately, patient registration was done based on all clinical and non-clinical manifestations. Results: Initially, a total of 151 data elements were approved with Delphi technique. The registry software went live at www. IRDReg.org based on DHIS2 open source license agreement since February 2016. So far, a total of 1001 patients have been registered with a mean age of 32.41±15.60 years (range, 3 months to 74 years). The majority of the registered patients had retinitis pigmentosa (42%, 95% CI: 38.9% to 45%). Genetic testing was done for approximately 20% of the registered individuals. Conclusion: Our study shows successful web-based software design and data collection as a proof of concept for the first IRD registry in Iran. Multicenter integration of the IRD registry in medical centers throughout the country is well underway as planned. These data will assist researchers to rapidly access information about the distribution and genetic patterns of this disease.

Purpose: To report the successful management of a case of tuberculosis (TB) related multifocal serpiginous-like choroiditis with anti-TB medications alone. Methods: A case report with multimodal imaging. Results: A 28-year-old man presented with progressive loss of vision in his left eye. He mentioned a similar history for his right eye about 2 years earlier. Fundus examination showed multiple discrete greyish irregularly bordered lesions in both eyes. Based on a highly positive skin tuberculin test and exclusion of other possible causes, a diagnosis of presumed TB associated multifocal serpiginous-like choroiditis was made, and quadruple classic anti-TB therapy was initiated. One year after introduction of anti-TB treatment, active lesions turned into scars, with significant improvement of vision. Conclusion: Anti-TB therapy may be enough as the only necessary treatment for TB-related serpiginous-like choroiditis. Keywords: Multifocal serpiginous-like choroiditis, Tuberculosis, Anti tuberculosis therapy

The neurotransmitter γ-aminobutyric acid (GABA) is involved in the process of memory. It has been reported that the inhibition of GABAB receptors has beneficial effects on cognition. The aim of this study was to investigate the role of CGP35348 (a GABAB receptor antagonist) on dentate gyrus GABAB receptor inhibition and its effects on learning and memory impairments that had been induced in adult male rats by microinjection of β-amyloid (Aβ). Seventy Wistar male rats were randomly divided into seven groups: control, sham (receiving the Aβ vehicle only), Aβ, Aβ + CGP35348 (1, 10, and 100 μg/μL), and CGP35348 alone (10 μg/μL). Memory impairment was induced by unilateral interventricular microinjection of Aβ (6 μg/6 μL). Rats were cannulated bilaterally in the dentate gyrus, and then, they were treated for 20 consecutive days. Learning and memory were assessed using the novel object recognition and passive avoidance learning tests. The discrimination index and the step-through latency were significantly increased in the Aβ + CGP35348 group in comparison to the Aβ only group (P

Recent reports indicated that curcumin had beneficial effects in animal models of liver injury and cirrhosis. Current study aimed to investigate the effects of curcumin supplementation in patients with liver cirrhosis. In this randomized double-blind placebo-controlled trial, 70 patients with liver cirrhosis aged 20-70 years were randomly divided into two groups to receive 1,000 mg/day curcumin (n = 35) or placebo (n = 35) for 3 months. Model for end-stage liver disease (MELD) (i), MELD, MELD-Na, and Child-Pugh scores were used to assess the severity of cirrhosis. Sixty patients (29 in the curcumin group and 31 in the placebo group) completed the study. MELD(i) (15.55 ± 3.78 to 12.41 ± 3.07), MELD (15.31 ± 3.07 to 12.03 ± 2.79), MELD-Na (15.97 ± 4.02 to 13.55 ± 3.51), and Child-Pugh (7.17 ± 1.54 to 6.72 ± 1.31) scores decreased significantly in the curcumin group after 3-month intervention (p < .001, p < .001, p = .001, and p = .051, respectively), whereas they increased significantly in the placebo group (p < .001, p < .001, p < .001, p = .001, respectively). Significant differences were only observed between the two groups in MELD(i), MELD, MELD-Na, and Child-Pugh scores after 3-month intervention (p < .001 for all of them). In this pilot study, beneficial effects of curcumin supplementation were observed in decreasing disease activity scores and severity of cirrhosis in patients with cirrhosis.

Background: The purpose of this study was to compare the effects of saffron and methylprednisolone on bleomycin-induced pulmonary fibrosis in rats. Methods: This study was conducted in Bushehr, southern Iran in 2017.The animals were divided into four groups of five rats each. Three groups were injected with a single intratracheal dose of bleomycin (5 mg/kg). The fourth group was administered with normal saline at the same volume (200 µl). Saffron extract dissolved in water was given to one group (100 mg /body weight) orally while intraperitoneal injection of methylprednisolone (2.5 mg/kg) injected to another one for 16 days. The rats were sacrificed 28 days following surgery and their right and left lungs were removed and washed for measuring lung indices, myeloperoxidase activities and finally histopathological examination. Results: Injection of bleomycin caused decrement of body weight aggravated by intraperitoneal methylprednisolone treatment. Lung indices were increased in the bleomycin-treated group compared with the control, while methylprednisolone, unlike saffron, had no preventive effects on it. Both saffron and methylprednisolone treatment prevented the increase in lung myeloperoxidase as a destructive enzyme. In addition, excessive collagen deposition and thickening of alveolar septa were significantly prevented with saffron treatment as compared to methylprednisolone injection following hematoxylin and eosin staining. Conclusion: Saffron with established antioxidant properties could prevent some detrimental effects in bleomycin-induced pulmonary fibrosis even more than methylprednisolone injection known as a standard therapy in this murine model. More investigations must be carried out to examine the beneficial or harmful effects of this remedy.

Introduction: Twin pregnancies are associated with a risk of premature delivery. Case presentation: A 34-year-old primiparous female patient with twin pregnancy presented in the 26th week of pregnancy with a cervical length of 11 mm, with prolapse of membranes. The patient received specialized bed rest and support, and the pregnancy was successfully completed at 36 weeks and 5 days. Conclusion: In the second half of the pregnancy, due to the risk of emergency cervical cerclage, expectant management seems an appropriate and safe approach.

Purpose: To present a rare manifestation of macular telangiectasia type 2 (MacTel type 2) followed up for over six years. Methods: A 61-year-old woman with one year history of blurred vision of her left eye was referred. Results: Whereas the funduscopy, spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), and fundus autofluorescence (FAF) were normal in the right eye, they revealed noticeable findings typical of MacTel type 2 in the left eye. After over six years follow-up, OCT-angiography (OCTA) showed no remarkable difference between the two eyes, and en face OCT showed subtle abnormal change in the right eye as well as typical pathological changes in the left eye. Conclusion: MacTel type 2 can present unilaterally and remain so for a long time. The role of multimodal imaging in diagnosis and follow-up is of utmost importance. Keywords: Unilateral, Macular telangiectasia type 2, Multimodal imaging

Introduction: We report a rare case of non-insulin secreting malignant insulinoma of the pancreas and discuss its medical and surgical management. Case Presentation: Our patient was a 62- year-old Persian female. Over the previous year, she had developed increased abdominal mass, dizziness, weakness, and fatigue. After surgical operation, chemotherapy was given to the patient. Treatment with cisplatin and etoposide was commenced in a 4-month course. Conclusion: As a result, chemotherapy showed an important role in the management of insulinoma.

Background Globally, hepatitis B and schistosomiasis (Mansoni) together affect about 300 million people; which cause hepatic disorders worldwide. Given that little is known about co-infections with hepatitis B and schistosoma mansoni, the present study investigates these two health problems alone and together and their possible correlation. Methods A search was conducted for reports published between January 1990 and October 2020 by using Embase, Scopus, PubMed, Web of Science databases; Out of a total of 20 studies, 14 cross-sectional studies (6329 people) and 6 case-control studies (2138 individual) were reviewed. The pooled prevalence of hepatitis B virus (HBV), S.mansoni infections, and their co-infections; heterogeneity and the Odds Ratio (OR) were evaluated by Stata 11.2. Findings Among the included studies in the inclusion criteria, the pooled prevalence of hepatitis B, S. mansoni was 34% (95% CI, 0.23–0.46), 41% (95% CI, 0.24–0.59) and their co-infections was 18% (95% CI, 0.11–0.25) by regions. The hepatitis B and S. mansoni correlation was significant in populations with schistosoma compared to control group (OR, 2.12; 95% CI, 1.36–3.30). Commentary Our results showed that in addition to the high global prevalence of hepatitis B- S. mansoni (co) infections in the included studies, there is a significant association between them, especially in people suffering from schistosoma. These results highlight the importance of integrated interventions measurements against coexistence of parasitic and viral diseases. We know that more research studies need to be done in this field and global monitoring should be considered for the co-infection of these two important complications.