Novelty in Biomedicine

Background: Susceptibility-weighted imaging (SWI), an advanced MRI technique, has a high sensitivity in detecting microvascular changes, hemorrhages, and calcifications, thereby improving the diagnosis and management of various neurological pathologies. This study evaluated the frequency of abnormal findings in SWI sequence in patients with brain pathologies referred to Loghman Hakim Hospital.

Materials and Methods: This cross-sectional study was conducted on patients with various brain pathologies who underwent brain MRI with SWI sequence at Loghman Hakim Hospital from October 2021 to October 2022. The frequency of different brain pathologies in the SWI sequence was assessed.

Results: A total of 157 brain pathologies were evaluated. In 129 cases (82.2%), the most probable lesion diagnosis was only found in the SWI sequence. Thrombosis in veins was found in all cerebral venous thrombosis (CVT) patients in SWI and other sequences. Hemorrhage in venous infarct was observed in 20% of CVT cases. In patients with vascular malformations, the diagnosis of cavernoma was made in 9 patients (81.8%) and capillary telangiectasia in 2 patients (18.2%).

Conclusion: The findings of this study demonstrated the significant role of SWI in evaluating various brain pathologies, especially in cases where routine MRI sequences are not diagnostic. Therefore, we recommend using SWI in routine brain MRI.

Background: Gastric bypass and sleeve gastrectomy are two common types of bariatric surgery. Anastomotic leak is one of the common and fatal complications of these surgeries. The current study compared the leakage rate after sleeve gastrectomy and gastric bypass.

Materials and Methods: This cross-sectional study was performed on patients who underwent bariatric surgery in Mortaz and Mojibinia Hospitals (Yazd-Iran) from 2016 to 2020. Age, sex, body mass index (BMI) before surgery, underlying disorders, surgery types (sleeve gastrectomy or gastric bypass), amount of weight loss, leakage, duration time between the end of the surgery, and occurrence of leakage were recorded. The patients were followed up for three months. The patients were observed for the presence of the leakage for two weeks after the operation.

Results: A total of 713 patients were enrolled in the study; 427 underwent sleeve gastrectomy (59.89%), and 286 underwent gastric bypass surgery (40.11%). Of these patients, 43.3% were male. The age of performing the surgery significantly differed between the groups (P-value: 0.031). The gastric bypass group lost more weight than the sleeve gastrectomy group (P-value <0.001). The leakage rate was higher in patients operated on by gastric bypass than those operated on by sleeve gastrectomy (P-value = 0.032). Leakage time significantly differed between the groups (P-value = 0.043).

Conclusion: Bypass gastrectomy has a higher leakage rate than sleeve gastrectomy, but it has a higher effect on weight loss.

Background: Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease. Obese children and adolescents, particularly those with metabolic syndrome (MetS), commonly report NAFLD, which can lead to various other problems and diseases. There are different opinions on how the liver fibrosis score, insulin resistance indices, and risk of cardiovascular disease are related in people with NAFLD who have different body mass index (BMI) levels. This study aimed to investigate the relationship between liver fibrosis score, insulin resistance indices, and cardiovascular disease risk in patients with NAFLD, specifically focusing on two groups with normal and high BMI.

Materials and Methods: This analytical cross-sectional study was conducted on patients with NAFLD referred to Taleghani Hospital (Tehran-Iran) between 2019 and 2020. Data such as age, gender, BMI, height, weight, blood sugar level, hemoglobin A1C level, lipid profile, liver fibrosis level, insulin resistance level, liver aminotransferases level, Framingham risk score, and presence of MetS were evaluated. The significance level was considered less than 0.05.

Results: We evaluated 140 patients, 14 of whom had normal BMI, and the rest had high BMI. There was a significant relationship between the homeostatic model assessment for insulin resistance (HOMA-IR) index and the liver fibrosis score. For a one-unit increase in the liver fibrosis score, the HOMA-IR score increased by 0.287 times (P-value=0.001). There was a significant relationship between MetS and the risk of cardiovascular diseases based on the Framingham risk score and liver fibrosis (P-values<0.05).

Conclusion: High BMI levels can increase the incidence of NAFLD, Framingham, and HOMA-IR indices.

Background: This study aims to evaluate the correlation between anti-Müllerian hormone, luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone, Estradiol, and vitamin D in women experiencing secondary infertility.

Materials and Methods: In this retrospective study, we enrolled 97 women with secondary infertility who underwent treatment between 2012 and 2022. Information regarding each couple, including names (confidential and coded), ages, causes of infertility, number of children and abortions, and duration of infertility were collected. Laboratory test results were gathered, which included gonadotropin and estradiol hormone levels measured on the second to third day of menstruation, as well as anti-Müllerian hormone, thyroid-stimulating hormone, and vitamin D levels. The data were analyzed using SPSS software (version 26).

Results: The mean ages of females and males were 33/5±4/4 and 36/5±5/6 years, respectively. There was no significant correlation between vitamin D and estradiol and other hormone levels. In addition, there was a significant positive correlation between the follicle-stimulating and luteinizing hormones (P = .021). The luteinizing hormone also showed a significant negative correlation with the thyroid-stimulating hormone (P=.019). Conversely, anti-Müllerian hormone correlated negatively with follicle-stimulating hormone (P < 0.01). The age of females had a negative significant correlation with anti-Müllerian hormone (P=0.002).

Conclusion: According to our study, as women age, their anti-Müllerian hormones decrease, and their follicle-stimulating hormone levels increase. In addition, the study found a correlation between luteinizing hormone and thyroid-stimulating hormone, indicating a potential interplay between thyroid function and reproductive hormones. The findings emphasize the complex relationships between age, hormonal levels, and secondary infertility.

Background: Campylobacter jejuni is an important pathogenic bacterium that is associated with diarrhea and gastroenteritis in several animal species and humans. The secretion of virulence factors is a crucial strategy that enteric bacterial pathogens use to interact with host cells, promote their survival, and damage the host. Many bacterial pathogens utilize outer membrane vesicles (OMVs) to deliver virulence factors into host cells. C. jejuni can produce nanosized OMV cargos, which have been proposed to have a key role in disease progression, pathogenesis, and immune system modulation. This study aimed to assess the effect of OMVs derived from C. jejuni on the survival of HT-29 intestinal cells in vitro.

Materials and Methods: In this work, C. jejuni clinical strain RIGLD 4-151 was used. C. jejuni OMVs were isolated using ultracentrifugation and were analyzed by scanning electron microscopy (SEM) and dynamic light scattering (DLS). HT-29 human colon cancer epithelial cells were treated with OMVs for 24, 48, and 72 hours. Cell viability of HT-29 cells exposed to OMVs was measured by MTT assay.

Results: Our results showed that C. jejuni strain RIGLD 4-151 released round-shaped nanovesicles ranging from 10 to 250 nm. The cytotoxicity assays unveiled a dose-dependent reduction in cell viability following exposure to various concentrations of C. jejuni OMVs.

Conclusion: The present study demonstrated that OMVs derived from C. jejuni strain RIGLD 4-151 can significantly affect viability of HT-29 cells. Further research is required to elucidate the definite role of OMVs derived from C. jejuni strain RIGLD 4-151 in the pathogenesis of C. jejuni.

Background: Unprovoked venous thromboembolism (VTE) can occur without traditional risk factors, and its underlying causes remain poorly understood. This study investigates the potential role of elevated antinuclear antibody (ANA) titers as a biomarker for unprovoked VTE.

Materials and Methods: A case-control study was conducted with 189 patients diagnosed with unprovoked VTE, and 189 matched controls without VTE between 2019 and 2023. ANA titers were measured using enzyme-linked immunosorbent assay (ELISA), and the association between elevated ANA titers and unprovoked VTE was assessed.

Results: The study revealed a significant association between elevated ANA titers and unprovoked VTE. The case group had a higher proportion of patients with ANA titers >1:100 (14.3%) compared to controls (3.7%) (p<0.001). Laboratory analysis showed significantly higher white blood cell count (p<0.001), lower mean corpuscular volume (p=0.03), and higher creatinine levels (p<0.001) in the case group. No significant differences were observed in hemoglobin or platelet levels (p=0.07 and p=0.89, respectively).

Conclusion: Elevated ANA titers may serve as a useful biomarker for identifying patients at risk for unprovoked VTE. Clinicians should consider autoimmune disorders in the differential diagnosis for unprovoked VTE. Early detection of elevated ANA could lead to targeted interventions and improved patient outcomes by reducing VTE recurrence and managing underlying autoimmune conditions.

Background: Colistin, a last-resort antibiotic, faces a growing threat from antibiotic resistance. This study aims to comprehensively assess colistin resistance in clinical isolates of Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae in Iran.

Materials and Methods: Relevant studies on the prevalence of colistin resistance among multidrug-resistant Gram-negative bacteria in Iran, published up to December 15, 2023, were identified through searches of databases such as PubMed/Medline, EMBASE, and Scopus. The overall frequency of colistin resistance for each bacterial species was determined using CMA version 3.

Results: The comprehensive analysis of clinical isolates revealed varying frequencies of colistin resistance among the studied Gram-negative bacteria. E. coli displayed a resistance rate of 3.6%, while P. aeruginosa exhibited a rate of 6.5%. A. baumannii demonstrated a resistance rate of 4.7%, and K. pneumoniae displayed the highest resistance rate at 7.2%. Importantly, the analysis found no significant evidence of publication bias, enhancing the reliability of these resistance rate estimates.

Conclusion: Colistin resistance among these clinically significant Gram-negative bacteria in Iran is rising, limiting treatment options and posing serious challenges to healthcare providers. These findings underscore the urgency of enhanced surveillance, the development of alternative treatments, and the implementation of strict infection control measures. Addressing colistin resistance is crucial to effectively managing infections caused by these pathogens in Iran and globally.

Background: Stress-induced hyperglycemia, also known as stress hyperglycemia, occurs after severe stress on the body, such as surgery. Awareness of this condition and its management are essential to reducing complications and mortality in patients after general surgery. This study aimed to review studies conducted on stress hyperglycemia in patients who underwent general surgery.

Materials and Methods: This review study investigated the outcomes and management of stress hyperglycemia in general surgery patients. From 2014 to 2024, the keywords “stress hyperglycemia” and “general surgery” were searched in the PUBMED, ELSEVIER, and CENTRAL databases.

Results: The incidence of stress hyperglycemia varies between studies but often occurs in more than 20% of patients. Compared with diabetic patients undergoing general surgery, patients with stress hyperglycemia have more severe rates of complications and mortality. Complications of stress hyperglycemia include infection, necrosis, organ damage, and mortality. Stress hyperglycemia can also increase the length of hospital stay.

Conclusion: The results of this study showed that stress hyperglycemia was common in people who had general surgery and was linked to a higher risk of complications and death compared to patients who did not have hyperglycemia or diabetes.

Background: Candidiasis is among the most widespread infections caused by fungi species. Although C. albicans still serves as the primary source of this infection, the occurrence and antifungal resistance of non-Candida albicans species seem to be increasing.

Materials and Methods: The data was gathered from multiple sources across Pubmed and Google Scholar using candidiasis, anti-fungal resistance, epidemiology, non-Candida albicans species, and Iran. Different types of articles from 2016 to 2024 regarding candidiasis in various regions of Iran and cases of resistant non-Candida albicans species were included.

Results: In this review article, we analyzed the susceptibility of non-Candida albicans species to multiple anti-fungal agents and observed variable resistance patterns to commonly used agents. However, fluconazole showed resistance more often than other agents, and amphotericin B showed the least amount of resistance overall.

Conclusion: This study aimed to demonstrate the importance of geographical factors and causative species in Iran's resistance pattern and treatment of candidiasis. This can help medical practitioners prescribe the optimum therapeutic agent for candidiasis patients.