Unilateral renal mucormycosis in a patient presenting with pyelonephritis and acute kidney failure: A case report.

Key Clinical Message: Unilateral renal mucormycosis is a rare infection that should be suspected in patients with recurrent renal infections presenting nonspecific clinical features that do not respond to conventional therapies, especially in impaired immune systems due to related risk factors. Moreover, histopathological examinations should be performed to confirm the diagnosis. For treatment, the preference is that the patient is hospitalized, and surgical intervention and rapid administration of intravenous antifungals for 2-3 weeks are the treatment choices. After discharge, the patient should be followed up with periodic blood urea nitrogen and creatinine levels and, if needed, an imaging modality such as a CT scan or sonography. Abstract: Renal mucormycosis (RM) is a rare form of mucormycosis infection and is more often in immunocompromised patients with risk factors. Unilateral renal involvement is infrequent in patients and is available as case reports. This condition usually presents with renal colic, fever and chills, and oliguria and has a high mortality rate. Herein, we report a case of unilateral renal mucormycosis presenting with pyelonephritis and acute kidney injury in a 32-year-old patient. The patient had numerous urological procedures in previous years due to nephrolithiasis state, which put him in an immunocompromised state. The histopathological examination of the pylocalyceal system revealed a collection of broad non-septated fungal hyphae branching at 90° accompanied by numerous neutrophils and necrotic tissue in favor of mucormycosis. He was successfully treated with 5 mg/kg/day Liposomal Amphotericin B for 3 weeks, discharged with good general condition, and remained asymptomatic for 3 months after discharge. The diagnosis of RM relies on solid clinical suspicion, which can be authenticated by histopathological examination, and the combination of antifungal therapy and surgical intervention can result in a good outcome.

The association of atherogenic index of plasma with cardiovascular outcomes in patients with coronary artery disease: A systematic review and meta-analysis.

BACKGROUND: Atherogenic index of plasma (AIP) represents a novel marker in the current era of cardiovascular diseases. In this meta-analysis, we aimed to evaluate the association of AIP with cardiovascular prognosis in patients with coronary artery disease (CAD). METHODS: PubMed, Scopus, and Web of Science databases were searched from inception through 2024. The primary outcome was major cardiovascular events (MACE). The secondary outcomes included all-causes death, cardiovascular death, myocardial infarction (MI), stroke, revascularization, and no-reflow phenomenon. AIP was determined by taking the logarithm of the ratio of triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C). The data analysis was represented using the risk ratio (RR) along with a 95% confidence interval (CI). RESULTS: Sixteen studies with a total number of 20,833 patients met the eligible criteria. The pooled-analysis showed a significant increased risk of MACE in the highest AIP group compared with the lowest AIP group (RR = 1.63; 95% CI, 1.44-1.85; P < 0.001). A similar result was observed when AIP was regarded as a continuous variable (RR = 1.54; 95% CI, 1.30-1.83; P < 0.001). Besides, elevated AIP was associated with increased risk of cardiovascular death (RR = 1.79; 95% CI, 1.09-2.78; P = 0.02), MI (RR = 2.21; 95% CI, 1.55-3.13; P < 0.001), revascularization (RR = 1.62; 95% CI, 1.34-1.97; P < 0.001), no-reflow phenomenon (RR = 3.12 95% CI, 1.09-8.96; P = 0.034), and stent thrombosis (RR = 13.46; 95%CI, 1.39-129.02; P = 0.025). However, AIP was not significantly associated with the risk of all-causes death and stroke among patients with CAD. CONCLUSIONS: The results of this study demonstrated that increased AIP is an independent prognostic factors in patients with CAD. Further research is warranted to elucidate the potential development of targeted interventions to modify AIP levels and improve patient outcomes.

Systematic review and meta-analysis of levothyroxine effect on blood pressure in patients with subclinical hypothyroidism.

This study aims to evaluate the effect of levothyroxine therapy on blood pressure (BP) in patients with subclinical hypothyroidism (SCH). Were searched Six databases, and randomized controlled trials (RCT) and prospective cohort studies evaluating the effect of levothyroxine therapy on BP in patients with SCH were included. 37 articles (9 RCTs and 28 prospective cohorts) were included in this meta-analysis. Pooled analysis of RCT studies was insignificant; however, pooled analysis of 28 prospective cohort studies showed a significant difference before and after the therapy, reducing both systolic blood pressure (SBP) and diastolic blood pressure (DBP) (MD=-4.02 [-6.45, -4.58] and MD=-2.13 [-3.69, -0.56], both P-values<0.05). Levothyroxine therapy can play a role in lowering BP in patients with SCH. However, this effect is more observed in Caucasians, SCH patients with higher initial TSH followed by more remarkable TSH change to normal levels, and SCH patients with hypertension.

A systematic review on post-discharge venous thromboembolism prophylaxis in patients with COVID-19.

BACKGROUND: Coronavirus disease of 2019 (COVID-19) is associated with venous thromboembolism (VTE), not only during hospitalization but also after discharge, raising concerns about anticoagulant (AC) use for post-discharge COVID-19 patients. We aimed to systematically review the current literature on the possible benefits or risks regarding extended thromboprophylaxis. MAIN BODY: We searched related databases from December 1, 2019, to October 6, 2022, including studies on the necessity, duration, and selection of the ideal AC regarding extended thromboprophylaxis for post-discharge COVID-19 patients. The screening of the selected databases led to 18 studies and 19 reviews and guidelines. Studies included 52,927 hospitalized COVID-19 patients, with 19.25% receiving extended thromboprophylaxis. VTE events ranging from 0 to 8.19% (median of 0.7%) occurred in a median follow-up of 49.5 days. All included studies and guidelines, except four studies, recommended post-discharge prophylaxis after an individual risk assessment indicating high thrombotic and low bleeding risk. Studies used risk assessment models (RAMs), clinical evaluation, and laboratory data to identify COVID-19 patients with a high risk of VTE. IMPROVE-DD was the most recommended RAM. Direct oral anticoagulants (DOACs) and low molecular weight heparins (LMWHs) were the most used AC classes. CONCLUSIONS: Post-discharge prophylaxis for COVID-19 patients is recommended after an individual assessment. The IMPROVE-DD model can help predict VTE risk. After distinguishing patients who need post-discharge AC therapy, DOACs for 30-35 days and LMWHs for 40-45 days can be the drug of choice. Further studies, particularly the results of the ongoing randomized controlled trials (RCTs), are required. Also, to properly handle such patients, every physician should consider lifestyle modification in addition to pharmacological treatment for post-discharge VTE prophylaxis.

Effect of Obesity Duration and BMI Trajectories on Cardiovascular Disease: A Narrative Review.

Obesity is an important risk factor for cardiovascular diseases (CVDs). It is crucial to understand the impact of its duration due to the more extended exposure period and the higher frequency of overweight/obesity at younger ages. In the last decade, various studies have discovered that the duration of obesity, in addition to its severity, might have an impact. Therefore, this study aimed to summarize the current literature to investigate the effect of body mass index (BMI) trajectories and overweight/obesity duration on cardiovascular outcomes. To retrieve related articles, we searched PubMed, EMBASE, Google Scholar, Web of Science, Scopus, and Cochrane electronic databases. The duration of overweight/obesity is significantly associated with CVDs, especially heart failure and atrial fibrillation. However, there are contradictory results regarding the association between coronary heart disease and stroke with the duration of obesity. Additionally, no association with peripheral vascular disease has yet to be reported. The absence of this association may be brought on by covariates or various follow-up times. Nevertheless, it seems that both stable overweight and remarkably stable obesity increase the risk of CVDs, as does both stable overweight and notably stable obesity. Metrics showing both the severity and the duration of overweight/obesity are more effective than each alone, and it is recommended to be used for assessing the risk of various CVDs. There are few studies in these areas, and studies with more extended follow-up periods, with a wide age range, while adjusting for some specific covariates, are needed.

Diagnostic Accuracy of Ultrasonography for Detection of Intussusception in Children; a Systematic Review and Meta-Analysis.

Introduction: The diagnosis of intussusception can be challenging in children due to the fact that the findings of clinical evaluations are nonspecific and most of the patients present with unclear history. Therefore, in this systematic review and meta-analysis, we aimed to investigate the diagnostic accuracy of ultrasonography for detection of intussusception and also compare the efficacy of point-of-care ultrasound (POCUS) with radiologist-performed ultrasound (RADUS). Methods: Two independent reviewers systematically searched different online electronic databases including MEDLINE, Scopus, Web of Science, Google Scholar, Embase, and Cochrane from inception to December 1, 2022 to identify published papers reporting accuracy of ultrasonography for diagnosis of intussusception. The quality assessment of the included studies was investigated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. Results: A total of 1446 records were retrieved in the initial search of databases. After screening the titles, a total of 344 studies were retrieved for the detailed assessment of full-text. Finally, 37 studies were included in qualitative and quantitative analysis. The pooled sensitivity and specificity of ultrasonography for diagnosis of intussusception were 0.96 (95% CI: 0.95-0.97) and 0.97 (95% CI: 0.97-0.98), respectively. The pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 24.57 (95% CI: 8.26-73.03) and 0.05 (95% CI: 0.04-0.08), respectively. The area under the hierarchical summary receiver operating characteristic (HSROC) curve was 0.989. Mete-regression showed that there is no significant difference between diagnostic performance of POCUS and RADUS (p = 0.06 and rDOR (diagnostic odds ratio) = 4.38 (95% CI: 0.92-20.89)). Conclusion: This meta-analysis shows that ultrasonography has excellent sensitivity, specificity, and accuracy for diagnosis of intussusception in pediatric patients. Moreover, we found that diagnostic performance of POCUS is similar to that of RADUS for diagnosis of intussusception.

What About My Weight? Insufficient Weight Loss or Weight Regain After Bariatric Metabolic Surgery.

Context: This review study aimed to investigate the definition, etiology, risk factors (RFs), management strategy, and prevention of insufficient weight loss (IWL) and weight regain (WR) following bariatric metabolic surgery (BMS). Evidence Acquisition: Electronic databases were searched to retrieve relevant articles. The inclusion criteria were English articles with adult participants assessing the definition, prevalence, etiology, RFs, management strategy, and prevention of IWL/WR. Results: Definition: The preferred definition for post-BMS IWL/WR are the terms "Lack of maintenance of total weight loss (TWL)>20%" and "weight change in percentage compared to nadir weight or weight loss". Prevalence: The exact prevalence of IWL/WR is still being determined due to the type of BMS and various definitions. Etiology: Several mechanisms, including hormonal/metabolic, dietary non-adherence, physical inactivity, mental health, and anatomic surgical failure, are possible etiologies of post-BMS IWL/WR. Risk factors: Preoperative body mass index (BMI), male gender, psychiatric conditions, comorbidities, age, poor diet, eating disorders, poor follow-ups, insufficient physical activity, micronutrients, and genetic-epigenetic factors are the most important RFs. Management Strategy: The basis of treatment is lifestyle interventions, including dietary, physical activity, psychological, and behavioral therapy. Pharmacotherapy can be added. In the last treatment line, different techniques of endoscopic surgery and revisional surgery can be used. Prevention: Behavioral and psychotherapeutic interventions, dietary therapy, and physical activity therapy are the essential components of prevention. Conclusions: Many definitions exist for WR, less so for IWL. Etiologies and RFs are complex and multifactorial; therefore, the management and prevention strategy is multidisciplinary. Some knowledge gaps, especially for IWL, exist, and these gaps must be filled to strengthen the evidence used to guide patient counseling, selection, and improved outcomes.