Intracranial angiomatoid fibrous histiocytoma: report of a rare case

One rare and low-grade soft tissue tumor with intermediate malignant potential is angiomatoid fibrous histiocytoma (AFH) و which occurs mainly in children and adolescents. The tumor naturally tends to localrecurrence and recurrent hemorrhage but rarely to remote metastasis.AFH has been reported in different organs; however, there are rare reports of primary intracranial AFH. The diagnosis of AFH may be difficult due to its occurrence at multiple unusual anatomic sites and its spectrum of morphologic patterns; thus, it is especially importantto diagnose it correctly because of the small risk of metastasis and death. The lesion is simply confused with a hematoma, soft tissue hemangioma, or malignant fibrous histiocytoma from clinical and radiographical aspects.We report a case of intracranial AFH in a 5-year-old boy. The tumor is a heterogeneous intra-axial with a size of 78*73mm at the right front temporal. There was also an extra-axial mass measured 8*12mm at the left superior frontal lobe in favor of metastasis. The diagnosis was confirmed using radiographical, immunohistochemical, and molecular tests.AFH is a rare tumor with a high probability of misdiagnosis. Surgeons must be aware of the presence of AFH and conduct a careful followu

Primary dural lymphoma: a comprehensive literature review and report of a case

Primary dural lymphoma (PDL) is a subtype of primary central nervous system (CNS) lymphoma (PCNSL) with only an extra-axial dural location. It accounts for less than 1% of all CNS lymphomas. PDL is a sporadic CNS tumor, and in the preoperative period, because of imaging characteristics, it is usually mimicking a meningioma. Usually, PDL is a low-grade B-cell lymphoma with a relatively good response to surgical resection with or without radiotherapy. Here we reviewed 102 case reports of PDL in the literature. Then, we present the case of our patient with PDL and explain the complexity of our treatment approach

Association between serum vitamin D, hs-CRP, and prooxidant-antioxidant balance with anthropometric and biochemical parameters in patients with diabetic foot ulcers

Background. Oxidative balance and inflammatory processes affect wound healing phases, and their disruption is connected with delayed wound healing. The present study aimed to assess the association between serum hs-CRP, prooxidant-antioxidant Balance (PAB), and vitamin D with anthropometric and biochemical parameters in patients with diabetic foot ulcers (DFU).Methods. Thirty-two patients with DFU were included in this study. The Spearman correlation coefficient was used to evaluate the bivariate relationship between serum hs-CRP, PAB, and vitamin D with anthropometric characteristics, glycemic status, lipid profiles, homocysteine level, liver, and kidney function tests.Results. Our data showed a significant positive association between serum hs-CRP and insulin (r = 0.417, P = 0.027), uric acid (r = 0.629, P = 0.001), creatinine (r = 0.431, P = 0.022), erythema (r = 0.36, P = 0.049), and ESR (r = 0.560, P = 0.002). Moreover, hs-CRP negatively correlated with FBS (r = –0.427, P = 0.023), total bilirubin (r = –0.639, P = 0.001), direct bilirubin (r = –0.445, P = 0.033), LDL-cholesterol (r = –0.405, P = –0.032), BMI (r = –0.398, P = 0.033) and HTN (r = –0.450, P = 0.014). Serum PAB value negatively correlated with patients age (r = –0.460, P = 0.027), and BMI (r = –0.442, P = 0.035), and positively associated with insulin level (r = 0.431, P = 0.040). A significant positive association between serum vitamin D with patient sex (r = 0.379, P = 0.047), and QUICKI (r = 0.456, P = 0.029), and negative correlation with HbA1c (r = –0.381, P = 0.045) were also determined.Conclusions. This study demonstrated that serum hs- CRP, PAB, and vitamin D are significantly associated with some anthropometric and biochemical parameters with important clinical value in patients with DFU. Low levels of vitamin D and high levels of hs-CRP and PAB may have an important role in the pathogenesis of DFU

A Comparative Analysis of Clinical Characteristics and Laboratory Findings of COVID-19 between Intensive Care Unit and Non-Intensive Care Unit Pediatric Patients: A Multicenter, Retrospective, Observational Study from Iranian Network for Research in Viral

Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs). Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings. Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran. Results: Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9% vs. 1.9%, respectively; p<0.001). Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions

Effect of Intermediate-Dose vs Standard-Dose Prophylactic Anticoagulation on Thrombotic Events, Extracorporeal Membrane Oxygenation Treatment, or Mortality among Patients with COVID-19 Admitted to the Intensive Care Unit: The INSPIRATION Randomized Clinical Trial

Importance: Thrombotic events are commonly reported in critically ill patients with COVID-19. Limited data exist to guide the intensity of antithrombotic prophylaxis. Objective: To evaluate the effects of intermediate-dose vs standard-dose prophylactic anticoagulation among patients with COVID-19 admitted to the intensive care unit (ICU). Design, Setting, and Participants: Multicenter randomized trial with a 2 � 2 factorial design performed in 10 academic centers in Iran comparing intermediate-dose vs standard-dose prophylactic anticoagulation (first hypothesis) and statin therapy vs matching placebo (second hypothesis; not reported in this article) among adult patients admitted to the ICU with COVID-19. Patients were recruited between July 29, 2020, and November 19, 2020. The final follow-up date for the 30-day primary outcome was December 19, 2020. Interventions: Intermediate-dose (enoxaparin, 1 mg/kg daily) (n = 276) vs standard prophylactic anticoagulation (enoxaparin, 40 mg daily) (n = 286), with modification according to body weight and creatinine clearance. The assigned treatments were planned to be continued until completion of 30-day follow-up. Main Outcomes and Measures: The primary efficacy outcome was a composite of venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days, assessed in randomized patients who met the eligibility criteria and received at least 1 dose of the assigned treatment. Prespecified safety outcomes included major bleeding according to the Bleeding Academic Research Consortium (type 3 or 5 definition), powered for noninferiority (a noninferiority margin of 1.8 based on odds ratio), and severe thrombocytopenia (platelet count <20 �103/µL). All outcomes were blindly adjudicated. Results: Among 600 randomized patients, 562 (93.7) were included in the primary analysis (median interquartile range age, 62 50-71 years; 237 42.2% women). The primary efficacy outcome occurred in 126 patients (45.7%) in the intermediate-dose group and 126 patients (44.1%) in the standard-dose prophylaxis group (absolute risk difference, 1.5% 95% CI,-6.6% to 9.8%; odds ratio, 1.06 95% CI, 0.76-1.48; P =.70). Major bleeding occurred in 7 patients (2.5%) in the intermediate-dose group and 4 patients (1.4%) in the standard-dose prophylaxis group (risk difference, 1.1% 1-sided 97.5% CI,-� to 3.4%; odds ratio, 1.83 1-sided 97.5% CI, 0.00-5.93), not meeting the noninferiority criteria (P for noninferiority >.99). Severe thrombocytopenia occurred only in patients assigned to the intermediate-dose group (6 vs 0 patients; risk difference, 2.2% 95% CI, 0.4%-3.8%; P =.01). Conclusions and Relevance: Among patients admitted to the ICU with COVID-19, intermediate-dose prophylactic anticoagulation, compared with standard-dose prophylactic anticoagulation, did not result in a significant difference in the primary outcome of a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days. These results do not support the routine empirical use of intermediate-dose prophylactic anticoagulation in unselected patients admitted to the ICU with COVID-19. Trial Registration: ClinicalTrials.gov Identifier: NCT04486508. © 2021 American Medical Association. All rights reserved

Case Report - Generalized neutrophilic dermatosis: A rare presentation of myelodysplastic syndrome

We present a 30-year-old man admitted with generalized cutaneous lesions, fever and cough. Examination of skin biopsies of a papular lesion revealed dense neutrophilic infiltration of the upper dermis, so these lesions were diagnosed as neutrophilic dermatosis. Peripheral blood examination and bone marrow findings confirmed the diagnosis of myelodysplastic syndrome with excess blasts. The cutaneous lesions improved after administration of corticosteroid and follow-up bone marrow examination revealed a normocellular marrow. One year later he referred with acute myelogenous leukemia (AML-M0). Unfortunately, he did not respond to treatment and died a few months later due to disease progression

Generalized neutrophilic dermatosis: a rare presentation of myelodysplastic syndrome

We present a 30-year-old man admitted with generalized cutaneous lesions, fever and cough. Examination of skin biopsies of a papular lesion revealed dense neutrophilic infiltration of the upper dermis, so these lesions were diagnosed as neutrophilic dermatosis. Peripheral blood examination and bone marrow findings confirmed the diagnosis of myelodysplastic syndrome with excess blasts. The cutaneous lesions improved after administration of corticosteroid and follow-up bone marrow examination revealed a normocellular marrow. One year later he referred with acute myelogenous leukemia (AML-M0). Unfortunately, he did not respond to treatment and died a few months later due to disease progression

Effects of 4 week endurance training on PGC-1α expression in adipose tissue, ANGPTL8 serum concentrations and beta cells function of STZ diabetic rats

Background & Objective: Angiopoietin-like Proteins 8 (ANGPTL8) which secreted form adipose tissue due to downstream PGC-1α pathways, is the main factor for regeneration of beta cell. The aim of this study was to investigate the effect of 4 endurance training program on PGC-1α expression in adipose tissue, ANGPTL8 serum concentration and beta cell function (HOMA.B) in diabetic rats. Materials & methods: Male Wistar rats (N=24) divided in 3 groups include healthy control (HC), diabetic control (DC) and endurance training (ET). After induction of diabetes with STZ, training groups performed 4 weeks endurance training and real-time polymerase chain reaction (Real-Time PCR) method used for the relative expression of PGC-1α in visceral adipose tissue, the enzyme-linked immunosorbent assay (ELISA) method for measuring serum ANGPTL8 levels. Also beta cell number was counted with pancreases hematoxylin-eosin evaluation. Results analyzed with ANOVA. Results: The relative expression of mRNA PGC-1α was significantly increased in ET (P=0.001). Although ANGPTL8 levels increased in ET group, this change wasn’t significant (P=0.47). HOMA.B didn’t showed any significant change in ET (P=.0.08) but the number of beta cells in this group significantly increased (P=0.001). There was a positive correlation between relative mRNA PGC-1α and ANGPTL8 levels. Conclusion: Despite the positive and significant correlation between relative expression of mRNA PGC-1α and ANGPTL8, this increase wasn’t significant, but this could increases the number of beta cell in endurance training group. Further studies with differences training programs are recommended

Cost-utility analysis of Cryoballoon ablation versus Radiofrequency ablation in the treatment of paroxysmal atrial fibrillation in Iran.

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia (Calkins H, et al. 2012). There are various methods to treat AF of which Ablation is one of the most effective. We aimed to assess the cost-utility of Cryoballoon ablation (CBA) compared to Radiofrequency ablation (RFA) to treat patients with paroxysmal AF in Iran. A cost-utility analysis was done using a decision-analytic model based on a lifetime Markov structure which was drawn considering the nature of interventions and the natural progress of the disease. Costs data were extracted from medical records of 47 patients of Shahid Rajaie Cardiovascular Medical Center in Tehran in 2019. Parameters and variables such as transition probabilities, risks related to side effects, mortality rates, and utility values were extracted from the available evidence. Deterministic and probabilistic sensitivity analysis was also done. TreeAge pro-2020 software was used in all stages of analysis. In the base case analysis, the CBA strategy was associated with higher cost and effectiveness than RFA, and the incremental cost-effectiveness ratio was $11,223 per Quality-adjusted life year (QALY), which compared to Iran's GDP per capita as Willingness to pay threshold, CBA was not cost-effective. On the other hand, considering twice the GDP per capita as a threshold, CBA was cost-effective. Probabilistic sensitivity analysis confirmed the findings of base case analysis, showed that RFA was cost-effective and the probability of cost-effectiveness was 59%. One-way sensitivity analysis showed that the results of the study have the highest sensitivity to changes in the RFA cost variable. Results of sensitivity analysis showed that the cost-effectiveness results were not robust and are sensitive to changes in variables changes. Primary results showed that CBA compared to RFA is not cost-effective in the treatment of AF considering one GDP per capita. But the sensitivity analysis results showed considerable sensitivity to changes of the ablation costs variable