Prevalence of Hyponatremia in Intensive Care Unit Patients With Brain Injury in Shahid Beheshti Hospital of Kashan During 2012

Background: Hyponatremia is a common disorder in patients with brain injury. It can result in acute and chronic complications providing this electrolytic disorder is not diagnosed and treated in due time. Objectives: The aim of this study was to evaluate the prevalence of hyponatremia in 95 patients with brain injury hospitalized in the intensive care unit in Shahid Beheshti hospital of Kashan University of Medical Sciences. Patients and Methods: This trans-sectional study was conducted on brain injury patients (brain traumas, brain hemorrhage, meningitis and brain tumors) during their six-month stay in the Intensive Care Unit (ICU) in Shahid Beheshti hospital. The data was then analyzed after excluding cases of pseudohyponatremia. Results: Among the 95 patients with brain injury, mean age was 42.85 ± 22.59 years, while the hyponatremic patients had a mean age of 48.37 ± 24.03 years of which 69.5% were male and 30.5% were female. Prevalence and occurrence of hyponatremia were 31.6% and 9.29 ± 6.8 days, respectively. This study revealed no meaningful differences between age, sex, underlying disease and prevalence of hyponatremia. Conclusions: Our study showed an elevated frequency of hyponatremia in patients with brain injuries in the intensive care unit which demands effective approaches for accurate and timely diagnosis of this electrolyte disorder

Revolutionaries and spies: Spy-good and spy-bad graphs

We study a game on a graph $G$ played by $r$ {\it revolutionaries} and $s$ {\it spies}. Initially, revolutionaries and then spies occupy vertices. In each subsequent round, each revolutionary may move to a neighboring vertex or not move, and then each spy has the same option. The revolutionaries win if $m$ of them meet at some vertex having no spy (at the end of a round); the spies win if they can avoid this forever. Let $\sigma(G,m,r)$ denote the minimum number of spies needed to win. To avoid degenerate cases, assume |V(G)|\ge r-m+1\ge\floor{r/m}\ge 1. The easy bounds are then \floor{r/m}\le \sigma(G,m,r)\le r-m+1. We prove that the lower bound is sharp when $G$ has a rooted spanning tree $T$ such that every edge of $G$ not in $T$ joins two vertices having the same parent in $T$. As a consequence, \sigma(G,m,r)\le\gamma(G)\floor{r/m}, where $\gamma(G)$ is the domination number; this bound is nearly sharp when $\gamma(G)\le m$. For the random graph with constant edge-probability $p$, we obtain constants $c$ and $c'$ (depending on $m$ and $p$) such that $\sigma(G,m,r)$ is near the trivial upper bound when $r<c\ln n$ and at most $c'$ times the trivial lower bound when $r>c'\ln n$. For the hypercube $Q_d$ with $d\ge r$, we have $\sigma(G,m,r)=r-m+1$ when $m=2$, and for $m\ge 3$ at least $r-39m$ spies are needed. For complete $k$-partite graphs with partite sets of size at least $2r$, the leading term in $\sigma(G,m,r)$ is approximately $\frac{k}{k-1}\frac{r}{m}$ when $k\ge m$. For $k=2$, we have \sigma(G,2,r)=\bigl\lceil{\frac{\floor{7r/2}-3}5}\bigr\rceil and \sigma(G,3,r)=\floor{r/2}, and in general $\frac{3r}{2m}-3\le \sigma(G,m,r)\le\frac{(1+1/\sqrt3)r}{m}$.Comment: 34 pages, 2 figures. The most important changes in this revision are improvements of the results on hypercubes and random graphs. The proof of the previous hypercube result has been deleted, but the statement remains because it is stronger for m<52. In the random graph section we added a spy-strategy resul

Correlation between Epstein-Barr virus infection and disease activity of systemic lupus erythematosus: A cross-sectional study

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease for whose pathogenesis viral infections are important. The Epstein-Barr virus (EBV) is the main infectious etiological agent. This study aimed to quantitative evaluation of EBV in SLE patients. Materials and Methods: In this cross-sectional study, 40 patients with SLE diagnosed based on American College of Rheumatology criteria were selected using purposive sampling. All were included in the study after obtaining informed consent for participation. Whole blood samples were taken and buffy coat preparations were isolated to determine viral load using the real-time polymerase chain reaction method and assessment with the SLE disease activity index (SLE-DAI). Results: From a total of 40 patients, 37 cases (92.5%) were women. The EBV test was positive in 67.5% and mean viral load was 5396 ± 1891.9 copy/ml. Twenty of forty patients had active and 50% inactive disease, mean EBV viral loads being 6798 and 28.25 copy/ml, respectively (P-value = 0.003). In terms of the severity of disease activity, 17.5 % of female patients had mild to moderate activity, whilst 32.5% of them had severe activity, with respective viral loads of 5,803.3 and 29.73 copy/ml (P-value = 0.003). Conclusion: The Epstein-Barr viral load in SLE patients with active disease was found to be markedly higher than in inactive cases. Thus, EBV may have an important role in the pathogenesis and activity of SLE. Keywords: Epstein-Barr virus, viral load, systemic lupus erythematosus, real-time PCR, human, infectio

The study of factors associated with pregnancy outcomes in patients with systemic lupus erythematosus

Objectives: Systemic lupus erythematosus (SLE) is an autoimmune disease that can lead to unfavorable pregnancy complications in women. This study aimed to evaluate the factors associated with pregnancy outcomes in patients with SLE. Results: Fifty-nine pregnant women with SLE (121 pregnancies) participated in this retrospective cohort study. The mean age of the patients was 33.74 ± 3.80 years (range 21 to 48 years). Fetal loss occurred in 43.8 of pregnancies. The most common laboratory findings in SLE patients were antinuclear antibody (81.4) and anti-ds DNA positivity (54.2). High levels of C-reactive protein (CRP) during pregnancy, renal involvement, anti-double-stranded DNA positivity, anti-phospholipid antibody (APA) positivity and younger age at disease onset were significantly correlated with unfavourable pregnancy outcomes. A significant difference was observed between duration of SLE and low birth weight (P = 0.003), pre-eclampsia (P = 0.012) and still birth (P = 0.036). High CRP, APA positivity, anti-dsDNA positivity and kidney involvement were predictors of adverse pregnancy outcomes in SLE patients. Renal involvement increased risk of pregnancy with complication 8.5 times (OR = 8.5, 95 CI 1.396-63.373, P = 0.017). Antiphospholipid syndrome (APS) also was associated with an odds ratio of 5.18 (95 CI 1.681-13.647, P = 0.001). © 2020 The Author(s)

A case of antiphospholipid syndrome following gastric signet ring cell adenocarcinoma

Objective: Rare disease Background: Antiphospholipid syndrome (APS) is a rare autoimmune disease characterized by arterial, venous, and small-vessel thrombosis, pregnancy-related morbidity and the presence of antiphospholipid antibodies such as an-ticardiolipin antibody, and/or anti-beta2-glycoprotein I. In the recent years, APS was observed in patients with solid tumors and the renal cancer, lung carcinoma and breast tumors were the most common tumors linked with APS. Case Report: A 53-year-old female presented with pain and pitting edema of left lower extremity that had begun 6 months prior to hospitalization. Deep vein thrombosis (DVT) in the popliteal vein diagnosed by Doppler ultrasonogra-phy and the patient was treated with heparin followed by warfarin. Following subdural hematoma, anticoagu-lant therapy was stopped, and the patient underwent craniotomy. One month later, the patient returned with pain and DVT diagnosed in its right leg. Laboratory tests showed high levels of lupus anticoagulant, IgM and IgG anticardiolipin antibodies. Following a high alkaline phosphatase, diffuse bone marrow involvement was found by whole body bone scan. Looking to find primary tumor, a large infilterable lesion in gastric was seen by endoscopic images, and biopsy histopathology showed a signet ring cell adenocarcinoma. The patient re-fused chemotherapy and died 6 months after diagnosis. Conclusions: APS is associated with gastric signet ring cell adenocarcinoma. © Am J Case Rep, 2020

A Case of Knee Monoarthritis Caused by Mycobacterium Tuberculosis

BACKGROUND Skeletal involvement is an uncommon form of extrapulmonary Mycobacterium tuberculosis (MTB) that occurs in 1-3 of the patients. Knee joints may be affected in 8 of cases. CASE REPORT We reported a case of TB knee arthritis in a 35-year-old Afghan male who was referred to Kashan Rheumatology Clinic for pain and swelling in the left knee. The patient had no history of fever, chills, weight loss, or anorexia. His chest radiography was normal. The synovial fluid culture was positive for M. tuberculosis. Magnetic resonance imaging (MRI) of the left knee demonstrated a marked joint effusion, chondromalacia in the lateral patellar facet, and edema in the origin of the gastrocnemius muscle. The histopathologic examination revealed multiple granulomas with foci of necrosis. CONCLUSIONS This case demonstrated that clinicians should pay particular attention to the possibility of TB as the cause of chronic monoarthritis even when pulmonary involvement is not documented