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Purpose Vitamin D deficiency has been reported as a key factor in the development of infectious diseases such as respiratory tract infections and inflammatory processes like acute respiratory distress syndrome. However, the impact of vitamin D on the severity and outcome of COVID-19 is still not fully known. Herein, we aimed to evaluate the prognostic role of serum vitamin D concentration on the extent of lung involvement and final outcome in patients with COVID-19. Methods Seventy-three subjects with confirmed diagnosis of COVID-19 were investigated in this study. The patients had been admitted to our academic hospital from February 28, 2020 to April 19, 2020. Demographic and clinical data, serum 25(OH)D levels, and findings of initial chest computed tomography were recorded. Linear and binary logistic regression, cox regression and ROC curve tests were used for statistical analysis. Results The mean age of patients was 55.18 ± 14.98 years old; 46.4% were male. Mean serum 25(OH)D concentration was significantly lower in the deceased (13.83 ± 12.53 ng/ mL compared with discharged patients (38.41 ± 18.51 ng/mL) (P

Coronavirus disease 2019 (COVID-19) is a novel and highly contagious disease caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Older adults and patients with comorbidities and immunosuppressive conditions may experience severe signs and symptoms that can lead to death. This case series assesses the clinical course, imaging features, and outcomes for 12 patients with COVID-19 and a history of kidney transplantation. Patients were evaluated for symptoms, laboratory data, imaging findings, and outcomes from February 2020 to April 2020. Fever, cough, and dyspnea were the most common clinical symptoms, noted in 75% (nine/12), 75% (nine/12), and 41.7% (five/12) of the patients, respectively. Most of the patients had a normal white blood cell count, while 33.3% (four/12) had leukopenia and 8.3% (one/12) had leukocytosis. A combination of consolidation and ground glass opacity was the most predominant (75%) pattern of lung involvement on computed tomography (CT). Eight patients died of severe COVID-19 pneumonia and acute respiratory distress syndrome and four were discharged. All recovered cases had a unilateral peripheral pattern of involvement limited to only one zone on initial chest CT. It seems that CT imaging has an important role in predicting COVID-19 outcomes for solid organ transplant recipients. Future studies with long-term follow up and more cases are needed to elucidate COVID-19 diagnosis, outcome, and management strategies for these patients.

Background Coronavirus infection is a novel respiratory disease affecting people across the world. Although the majority of patients present with fever, dyspnea, cough, or myalgia, various signs and symptoms have been reported for this disease. Recently, neurological symptoms have been noticed in patients with COVID-19 with unknown etiology. However, the occurrence of strokes in young and middle aged patients with COVID-19 is not fully explained. Methods In this series, six patients younger than 55 years of age with diagnosis of stroke and a confirmed diagnosis of COVID-19 were evaluated for symptoms, lab data, imaging findings, and outcomes from March 2020 to the end of April 2020 from all stroke cases in a tertiary academic hospital. Patients older than 55 and all others who had evidence of cardiac abnormalities (arrhythmia/valvular) were excluded. Results Fever, myalgia, cough, and dyspnea were the most common clinical symptoms noted in 66.66% (4/6), 66.66% (4/6), 50% (3/6), and 50% (3/6) of the patients, respectively. The mean ± standard deviation (SD) of National Institutes of Health Stroke Scale (NIHSS) for the patient was 10.16 ± 7.13 (ranged 5–24). The most involved area was middle cerebral artery (MCA) (five in MCA versus one in basal ganglia) and the majority of our patients had a low lung involvement score (mean ± SD: 13.16 ± 6.49 out of 24). Finally, one patient was deceased and rest discharged. Conclusion Stroke may be unrelated to age and the extent of lung involvement. However, different factors may play roles in co-occurrence of stroke and COVID-19 and its outcome. Future studies with long-term follow-up and more cases are needed to assess prognostic factors.

Purpose Due to a suggestive three-way relationship between brain structural disorders, microvascular lesions, and cognitive impairments, we aimed to examine the association of the volume and number of white matter hyperintensity lesions and lacunar infarcts with cognitive impairment among patients with cardiovascular risk factors in a sample of the Iranian population. Materials and methods This study was conducted on a total number of 156 normal subjects aged 30–74 years with cardiovascular risk factors. We used the Framingham general cardiovascular risk factors prediction model to calculate the likelihood of each risk factor. The total number of lacunar infarcts and the volume of white matter hyperintensity lesion were calculated in brain magnetic resonance imaging. Cognition status was assessed using the Montreal Cognitive Assessment questionnaire. Results An adverse association was revealed between Montreal Cognitive Assessment score and different cardiovascular risk profiles including the Framingham body mass index score ( p Conclusion Periventricular lesions are associated with impaired memory, language, and visuoconstruction while subcortical lesions are associated with impairment in naming, attention, language, and abstraction functions in normal subjects with cardiovascular risk factors but without cardiovascular or cerebrovascular disorders.

OBJECTIVE: Helicobacter Pylori (H. pylori) treatment may be different depending on the host and microbial factors in each region. The study was planned to estimate the effect of two 10-day esomeprazole containing clarithromycin and levofloxacin sequential therapies on H. pylori treatment. MATERIALS AND METHODS: Totally, 186 H. pylori-infected patients with gastro-duodenal ulcer who had not yet received treatment for infection, were enrolled. We randomly designated patients to group A (N = 94) who treated with esomeprazole 40 mg and amoxicillin 1 g bid during the early half of treatment, and continued the same dose of esomeprazole with levofloxacin 500 mg and tinidazole 500 mg bid during the second half of treatment and Group B (N = 92) who treated with the identical treatment excepting clarithromycin 500 mg bid as a substitute of levofloxacin. To assess eradication, C14-urea breath test was implemented 8 weeks afterward treatment. RESULTS: Finally, 172 patients completed the trial. We calculated 85.1% (95% confidence interval [CI] = 77.9–92.3) and 83.7% (95% CI = 76.2–91.2) eradication intention-to-treat analysis (P = 0.302) and so, 93.0% (95% CI = 87.6–98.4) and 90.0% (95% CI = 83.6–96.3) eradication by per-protocol analysis (P = 0.420) for Group A and B, respectively. No significant difference was seen among regimens. Drug adverse reactions were not significantly different between regimens. Group A had a 97.8% adherence rate to treatment and Group B had 98.9%. CONCLUSIONS: Both esomeprazole containing sequential regimens including levofloxacin and clarithromycin showed good eradication rates in spite of significant differences in antimicrobial resistance patterns in vitro. The efficacy of esomeprazole in lowering gastric acidity beside its antimicrobial effect should be considered in H. pylori regimens.

Background and Aim: Mild cognitive impairment (MCI) is characterized by declined cognitive function greater than that expected for a person’s age. The clinical significance of this condition is its possible progression to dementia. MLC601 is a natural neuroprotective medication that has shown promising effects in Alzheimer disease. Accordingly, we conducted this randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of MLC601 in MCI patients. Methods: Seventy-two patients with a diagnosis of MCI were recruited. The included participants were randomly assigned to groups to receive either MLC601 or placebo. An evaluation of global cognitive function was performed at baseline as well as at 3-month and 6-month follow-up visits. Global cognitive function was assessed by Mini-Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) scores. Efficacy was evaluated by comparing global function scores between the 2 groups during the study period. Safety assessment included adverse events (AEs) and abnormal laboratory results. Results: Seventy patients completed the study, 34 in the MLC601 group and 36 in the placebo group. The mean changes (±SD) in cognition scores over 6 months in the MLC601 group were –2.26 (±3.42) for the MMSE and 3.82 (±6.16) for the ADAS-cog; in the placebo group, they were –2.66 (±3.43) for the MMSE and 4.41 (±6.66) for the ADAS-cog. The cognition changes based on both MMSE and ADAS-cog scores were statistically significant between the placebo and the MLC601 group (p < 0.001). Only 5 patients (14.7%) reported minor AEs in the MLC601 group, the most commonly reported of which were gastrointestinal, none of them leading to patient withdrawal. Conclusion: MLC601 has shown promising efficacy and acceptable AEs in MCI patients.

The presence of different autoimmune disorders in the same individual is called multiple autoimmune syndrome (MAS). One of these co-occurring conditions is autoimmune haemolytic anaemia (AIHA), which is characterized by the production of autoantibodies against red blood cells due to immune system malfunction and which results in severe tissue oxygenation disturbance. AIHA is not uncommon but occurs rarely in MAS; if it does, MAS is then classified as MAS type III. Herein, we describe a case of MAS type III including AIHA which was successfully treated with hydrocortisone with gradual resolution of symptoms. LEARNING POINTS The co-occurrence of multiple autoimmune disorders in the same individual is called multiple autoimmune syndrome (MAS). Autoimmune haemolytic anaemia is not uncommon but rarely occurs in MAS. The presence of one autoimmune disease should alert the physician to the possible presence of others.

The current knowledge on how to use stem cells therapeutically for improving motor function in patients with cerebral palsy is growing. The present review aimed at assessing clinical trials related to beneficial effects of stem cells in patients with cerebral palsy. Electronic searches including “stem cell” and “cerebral palsy” as keywords were conducted using PubMed, Ovid, Web of Science, Scopus, Cochrane library, and CINAHL till February 2016. Two assessors reviewed the methodological quality and eligibility of the retrieved articles, independently. Among 77 studies initially reviewed based on the keywords, only 6 clinical trials were identified that met the inclusion criteria. Pooled response rate of stem cell therapy to treat cerebral palsy was estimated by assessing the percentage of improvement with a gross motor function classification system score. The resulting pooled estimate indicated a 30.7% (95% CI: 25.80% to 35.69%) increase in the score, 1 to 6 months after cell transplantation. In this regard, the test for heterogeneity was statistically significant (I2 = 87.9%, χ2 = 41.22, P < 0.0001). Stem cell therapy has the potential to improve motor function in patients with cerebral palsy. However, promising results from limited studies warrant further research.

Imerslund-Grasbeck syndrome (IGS) is a rare syndrome characterized by clinical symptoms and signs of Vitamin B 12 deficiency and proteinuria. Our patient was a 5-year-old boy with pallor, lack of appetite, and low weight gain. Laboratory studies showed severe macrocytic anemia, normal reticulocyte count, negative direct coombs test, normal osmotic fragility, and autohemolysis test. He has had intermittent proteinuria since 3 years ago despite normal creatinine level and absence of hematuria or hypertension. Finally, based on low level of serum B 12 vitamin and normal folate level accompanied by asymptomatic proteinuria, the diagnosis of IGS was made. Furthermore, his sister has had laboratory abnormalities without any symptoms. IGS responded to B 12 replacement therapy dramatically but intermittent proteinuria persisted even after appropriate therapy.

Body stuffing is defined as ingestion of unpackaged or packaged illicit drugs in a quick process. The drugs have usually been wrapped loosely in cellophane, plastic bags, paper, or aluminum foil. Methamphetamine toxicity is a dangerous state that occurs during methamphetamine leakage from the ingested packages in the gastrointestinal tract. This is usually occurring with cocaine and heroin, but methamphetamine body stuffing may less commonly happen, as well. Accordingly, management of methamphetamine body-stuffers is an important subject that has remained a controversy in clinical and legal aspects. We have reported two body-stuffer cases who underwent exploratory laparotomy. Although surgery was done, it was not useful to exit packs and even led to severe methamphetamine toxicity. These cases show that surgical treatment may be ineffective and even harmful in body-stuffers. On the other hand, this report suggests that pre and post-operation abdominal CT-scan is necessary for evaluating surgical treatment in patients who are still symptomatic.

Leigh syndrome is a severe progressive neurodegenerative disorder with different clinical presentationsthat usually becomes apparent in the first year of life and rarely in late childhood and elderly years. It is causedby failure of mitochondrial respiratory chain and often results in regression of both mental and motor skills and might even lead to death. In some of the inherited neurodegenerative diseases like Alexander disease, head trauma is reported as a trigger for onset of the disease. We present a late onset Leigh syndrome in a 14-year-old girl whose symptoms were initiating following head trauma.

Background Tranexamic acid (TXA), a synthetic antifibrinolytic drug, is effective as a treatment for serious hemorrhage, including bleeding arising from major trauma and post-operative interventions. Significant acute gastrointestinal bleeding may have a poor outcome despite routine medical and endoscopic treatments. The aim of this study was to assess whether early intravenous and/or intravenous plus topical administration of TXA reduces the need for urgent endoscopy for acute gastrointestinal bleeding. Method This double-blind randomized clinical trial included 410 patients with proven acute gastrointestinal bleeding. All patients received conventional therapy. The subjects were randomized to three groups: (A) 138 patients received intravenous TXA (1 g q6h); (B) 133 patients received topical TXA (1 g single dose by nasogastric tube) plus systemic TXA; and (C) 139 patients received a placebo (sodium chloride 0.9%) for 24 hours. Subgroup statistical analyses were conducted for urgent endoscopy, mortality, re-bleeding, blood transfusion, endoscopic and/or surgical intervention rates, and health status. Results The time to endoscopy was significantly shorter in group C (15.58 ± 7.994, p Conclusions Our results showed that the antifibrinolytic properties of TXA can aid in changing an urgent endoscopy to an elective procedure, with better outcomes for both physicians and patients.

Multiple sclerosis (MS) requires long-term therapy and can affect many aspects of a patient's life, including quality of life. MS patients score lower on health-related quality of life (HRQoL) measures. The efficacy of subcutaneous interferon (IFN) β-1a has been extensively evaluated by using objective measures but its impact on HRQoL is currently unclear. In this observational study, we evaluated HRQoL of Iranian patients with relapsing-remitting MS (RRMS) treated with IFN β-1a by using short-form 36 (SF-36) and multiple sclerosis international quality of life (MusiQoL) questionnaires.Four hundred recruited RRMS patients were treated with human serum album free IFN β-1a for 1 year. Patients were required to fill in SF-36 and MusiQoL questionnaires at the first visit and at each follow-up visit. Expanded disability status scale (EDSS) evaluation was performed at baseline and at each visit. Comparisons in HRQoL between visits were calculated using Cohen's d effect size. The relationship between change in EDSS score and the score of each questionnaire was calculated using Pearson correlation coefficients.Three-hundred and eighty three completed the study. Two-hundred and thirty nine were female. Mean (SD) age was 28.75 (±5.49). After 1 year, overall MusiQoL Index score effect size was -0.16 and SF-36 physical component and mental component showed overall effect sizes of -0.28 and -0.53, respectively. Mean (range) EDSS change was 1 (1-4). Three-hundred and seventy four were clinically stable with mean (range) EDSS change of 0.1 (-2-0.5). Increase in EDSS was linked to a decrease in both MusiQoL and SF-36.We found that, HRQoL did not change significantly over the first year of therapy. Furthermore, decreases in HRQoL were inversely correlated with increases in EDSS score.

An important complication of chemotherapy is thromboembolic events that can occur during treatment course. In this way, Warfarin can be used as an efficient prophylactic agent to prevent these complications. Although bleeding is a common adverse effect of Warfarin, eosinophilia is a rare side effect of this drug. We have reported a 5-year-old boy with Burkitt lymphoma who underwent chemotherapy. In the course of chemotherapy, because of thrombosis of the left jugular vein, we initiated Warfarin as a prophylactic drug for TEE secondary to chemotherapy. Following Warfarin initiation, eosinophilia appeared and subsequent to cessation of drug, eosinophilia disappeared. This case is presented to point out physicians to consider eosinophilia as a rare adverse-effect of Warfarin and monitor blood cell differentiation regularly during the course of treatment with this drug.

Amyloidosis is an extracellular deposition of abnormal serum proteins. Systemic amyloidosis could involve different organs such as the spleen, liver, and kidneys. Renal artery microaneurysm is very rare in renal amyloidosis. We report a 44-year-old woman who was referred to our general hospital for evaluation of rising serum creatinine level, anemia, and pathological fracture. Two hours following renal biopsy, she developed severe pain in the left flank during voiding and ultrasonography revealed a large perinephric hematoma. She underwent angiography that incidentally showed pseudoaneurysm with diffused renal artery microaneurysm. The feeding artery to the pseudoaneurysm was completely ligated by an interventional radiologist. The subsequent histopathological report of the kidney revealed amyloidosis.

Background: Magnetic resonance imaging (MRI) plays a critical role in diagnosis of multiple sclerosis (MS) and detecting brain changes during the course of the disease, but many aspects of MR Imaging such as its relationship with MS disabilities has remained unrecognized yet. One of the MS disabilities is cognitive impairment (CI), with an incidence of about 45% to 60%. Objectives: The purpose of this study was to examine the relationship between cognitive function and the volume of the brain lesions by assessing some of the sub-items of cognition. Patients and Methods: We assessed cognition using the Montreal Cognitive Assessment (MoCA) Test and brain changes in 46 MS patients in whom brain changes were detected with 1.5 tesla MR Imaging. Brain lesions were classified in three regions consisting of juxtacortical, periventricular and infratentorial. Lesion volumes were estimated using MIPAV software. We used SPSS 20 for data analysis. Also, we classified patients according to age, gender, and education. Results: There were no significant correlation between total lesion volumes and MoCA score. But significant correlations between total lesion volumes with visuospatial/executive function were found in persons with higher education. Conclusions: White matter lesion volumes have influence on some of the cognition sub-items in MS patients. Furthermore, MRI determinants can be useful for clinicians to evaluate cognition in MS patients.

To perform an accurate approach to the spine specially for fracture stabilization a 3D model of spine surgical region may improve this mechanism and it can help the surgeon to have a deeper glance to this scenario. The pre-op planning facility is another advantage of the patient spine specific model to take a chance of making guides to direct pedicle screws safely and increase the pathomechanics of volumes of interest stability factor parallel with its mobility restoration. There are some algorithms for making 3D-reconstruction from CT or MR data-set but the main goal of in-vivo component 3D making is right component extraction from its peripheral segments to achieve the best judgment especially about the surgical approach. Here is a cervical vertebral bodies segmentation and 3D-reconstruction of two cervical adjacent levels combined with the registration process that is shown the intervertebral degree regarding to range of motion percent.