Glycosylated haemoglobin and coronary atherosclerosis in non-diabetic patients: is it a prognostic factor?

BACKGROUND: Some studies aimed to evaluate the relationship between HbA1c and coronary artery disease (CAD). However, it is well known that long-term glycometabolic disorders put the heart at risk for CAD. Considering the inconsistencies between previous studies, this study aimed to investigate the relationship between HbA1c and coronary artery atherosclerosis. METHODS: A cross-sectional study was conducted on 411 non-diabetic patients who underwent their first coronary angiography between November 2013 and December 2014 in Baqiyatallah Hospital. Blood samples were taken before angiography. Coronary angiograms were reported and reviewed by two cardiologists according to the Gensini score. They were not aware about the patients' HbA1c level. Severity of CAD was determined through ascertaining the prevalence of multi-vessel disease, extent of CAD (single-, two- or three-vessel disease or left main stem stenosis (>50%)). Data analysis was performed by using SPSS software. RESULTS: A total of 411 patients (252 men and 159 women) were evaluated. Angiography was normal in 67 patients (16.3%), 30.7% had single-vessel disease (SVD), and 29.1%, 20.7% and 3.2% had two-, three- and multivessel disease, respectively. Based on the ROC curve, the HbA1c was able to differentiate between patients with and without coronary atherosclerosis (p < .001, cut-off point = 5.45). The cut-off points for differentiation of severe CAD and patients with 75-100% stenosis of coronary artery were 5.55 (p < .001) and 5.65 (p < .001), respectively. CONCLUSIONS: The present study demonstrated that HbA1c might be an independent diagnostic factor in non-diabetic patients with severe coronary atherosclerosis.

Combination of sofosbuvir, pegylated-interferon and ribavirin for treatment of hepatitis C virus genotype 1 infection: a systematic review and meta-analysis.

BACKGROUND: Hepatitis C virus (HCV) infection is an important cause of chronic liver disease which has been affected 3% of world's population. Some studies have shown that adding Sofosbuvir (SOF), an HCV polymerase inhibitor to the conventional therapy of Pegylated-interferon (PegIFN) plus Ribavirin (RBV) can increase the rate of sustained virologic response (SVR) among HCV-infected patients. This study was conducted to determine the effect of combination therapy with PegIFN and RBV plus SOF for chronic hepatitis C genotype 1 infection using systematic review with meta-analysis. METHODS: In this study, electronic databases including PubMed, Scopus, Science Direct, and Web of Science were comprehensively searched using appropriate strategies containing all related keywords of "hepatitis C", "PegIFN", "RBV" and "SOF". Studies assessed the efficacy of combination therapy with PegIFN and RBV plus SOF for chronic hepatitis C genotype 1 infection were included in the meta-analysis. RESULTS: After screening of 757 records, we included five articles with total sample size of 411 to the meta-analysis. Based on the fixed-effect model (χ 2 = 5.29, P = 0.26 and I2 = 24.4%), pooled SVR rate for treatment regimen of PegIFN and RBV plus SOF was calculated as 88.54% (95% CI = 85.77%-91.32%). CONCLUSIONS: Combination therapy with PegIFN and RBV plus SOF results in high treatment response in patients with HCV genotype 1 infection.

Central Nervous System Toxoplasmosis in Relapsed Hodgkin's Lymphoma: A Case Report.

INTRODUCTION: Patients with immunosuppression have an increased incidence of toxoplasmosis characterized by involvement of the central nervous system. Only a few cases of toxoplasmosis associated with immunosuppressive agents have been reported. Such cases have been reported in immune suppressed patients outside the Iran, but a search of the literature has not revealed any previous reports from this country. CASE PRESENTATION: We described a 17- year -old male, a known case of Hodgkin's lymphoma with the diagnosis of central nervous system (CNS) toxoplasmosis. CONCLUSIONS: As a conclusion, CNS toxoplasmosis should be considered in the differential diagnosis of immunosuppressed patients who present with neurological manifestations.

Hepatitis A Virus Infection, Vaccination and Iranian Healthcare Workers.

CONTEXT: Hepatitis A virus (HAV) infection is an important public health problem. It is estimated that about 1.4 million cases of HAV infection occur every year worldwide. Non-immune healthcare workers (HCWs) can be at higher risk of HAV infection in comparison to general population and an appropriate preventive method should be considered for them. EVIDENCE ACQUISITION: For finding related articles, a comprehensive search was performed in Scopus, PubMed and Google Scholar and all appropriate combinations of following keywords were considered; "healthcare provider", "healthcare personnel", "healthcare worker", "nurse" "medical students", "Iran", "Hepatitis A" and "vaccination". Also we did a search in Persian language in Google scholar and scientific information database (SID) to find related Persian literature. RESULTS: A gradual shift in age of HAV infection has been seen from childhood toward adulthood. Data about HAV seropositivity among Iranian HCWs are very limited. However based on the recent studies, it seems that HAV seropositivity has been reduced among HCWs in comparison with the past. All recent studies have suggested HAV vaccination for HCWs. CONCLUSIONS: Available limited studies show that Iranian healthcare personnel need HAV vaccination. However, for selecting an appropriate preventive method for this high risk group, more original studies are still needed.

Acute pancreatitis induced by mycophenolate mofetil in a kidney transplant patient.

Acute pancreatitis is a rare life-threatening complication in patients after kidney transplantation. Here we described a 56-year-old man who had received a living related kidney transplant for an end-stage renal disease. In his regular follow-up, his serum creatinine was gradually increased and he underwent an allograft biopsy, which revealed an interstitial nephritis/tubular atrophy grade II. Mycophenolate mofetil (MMF) was prescribed to control chronic allograft nephropathy. He presented with complaints of severe abdominal pain, vomiting, loss of appetite and fever requiring hospital admission twelve days later. Acute pancreatitis was diagnosed on the basis of laboratory data and imaging findings during hospital admission. There was no history of alcohol consumption in our patient. Unfortunately he died one week later and autopsy findings demonstrated acute necrotizing pancreatitis. The bladder drainage of this patients was normal. Laboratory findings in this patient did not endorse infections and other possibilities regarding the etiology of acute pancreatitis in this patient. Therefore, we concluded that acute pancreatitis in near the patient was induced by drugs and basis on our evidence, MMF is the most important suspect. This study suggests that acute pancreatitis can be considered as a side effect of MMF.

Occult HCV Infection: The Current State of Knowledge.

CONTEXT: Occult HCV infection (OCI) is defined as the presence of HCV-RNA in hepatocytes and the absence of HCV in the serum according to usual tests. We aimed to define OCI and provide information about the currently available diagnostic methods. Then we focus on specific groups that are at high risk of OCI and finally investigate immune responses to OCI and the available treatment approaches. EVIDENCE ACQUISITION: PubMed, Scopus and Google Scholar were comprehensively searched with combination of following keywords: "occult", "hepatitis C virus" and "occult HCV infection". The definition of OCI, diagnostic methods, specific groups that are at high risk and available treatment approaches were extract from literature. An analysis of available articles on OCI also was done based on Scopus search results. RESULTS: OCI has been reported in several high-risk groups, especially in hemodialysis patients and subjects with cryptogenic liver disease. Furthermore, some studies have proposed a specific immune response for OCI in comparison with chronic hepatitis C (CHC). CONCLUSIONS: With a clinical history of approximately 11 years, occult HCV infection can be considered an occult type of CHC. Evidences suggest that considering OCI in these high-risk groups seems to be necessary. We suggest that alternative diagnostic tests should be applied and that there is a need for the participation of all countries to determine the epidemiology of this type of HCV infection. Additionally, evaluating OCI in blood transfusion centers and in patients who receive large amounts of blood and clotting factors, such as patients with hemophilia, should be performed in future projects.