Kounis syndrome type I induced by an intramuscular injection of diclofenac: A literature review based on a case report.

Key Clinical Message: The history of any allergy to the medications should be asked by physicians before administration of the medication. The coincidence of allergic and ACS symptoms after a short time of drug administration might be an indicator of Kounis syndrome. Allergic and coronary symptoms should be considered and treated. Abstract: Ischemic heart disease is still the leading cause of death worldwide. Some medications, including NSAIDS and antibiotics, can cause allergic reactions with cardiac manifestations due to spasms of the coronary arteries. In this case, we present a patient with chest pain syndrome due to a hypersensitivity reaction caused by an intramuscular (IM) diclofenac injection. The patient was a 51-year-old male who presented to the emergency department complaining of retrosternal chest pain, breathlessness, and pruritis that started half an hour after an IM diclofenac injection he had because of low back pain. The allergic symptoms subsided with an antihistamine injection, but chest pain and dyspnea remained stable. He was admitted due to the presence of ST-segment depression in leads II, III, and AVF and underwent percutaneous coronary angiography, which was normal. The patient was discharged with the diagnosis of Kounis syndrome, and he had an uneventful follow-up 1 year later. Kounis hypersensitivity-associated acute coronary syndrome, especially type I variant coronary spasm due to endothelial dysfunction is a type of acute myocardial syndrome. The following report describes an uncommon case of anaphylaxis-associated Kounis type I syndrome manifesting ST-segment changes in a male patient following an intramuscular injection of diclofenac.

Mechanical prosthetic valve thrombosis: A literature review of treatment strategies.

Mechanical prosthetic valve thrombosis (MPVT) is a common complication of valvular implantations. This study compared the efficacy and safety of different treatments for MPVT. A systematic search of electronic databases identified studies evaluating surgical, anticoagulant, and thrombolytic therapies. Although several studies of different types have been conducted to evaluate the efficacy of these treatment strategies the lack of randomized controlled trials has resulted in the inability to make a definitive conclusion about the pros and cons of these treatments. Recent treatments, such as slow and ultraslow infusion of thrombolytics, showed comparable efficacy and lower complication rates than traditional methods. Inadequate anticoagulant use is a major risk factor for MPVT, highlighting the importance of prevention. Treatment selection should be individualized based on patient factors and available expertise. Overall, slow and ultraslow infusion of thrombolytics may be a promising treatment option for MPVT.

The Persian version of the 8-item Morisky Medication Adherence Scale (MMAS-8): can we trust it?

Background: Diabetes mellitus (DM) is a common serious health problem. Medication adherence is a crucial determinant of therapeutic success in patients with diabetes mellitus. This study aims to examine the 8-item Morisky Medication Adherence Scale (MMAS-8) psychometric properties among diabetic patients. Methods: This study was carried out at the Internal Medicine clinic of Firooz Abadi Hospital in Tehran, Iran, from 2018 to 2020. The English version of the MMAS-8 was translated into Persian and administered to patients with diabetes mellitus. A total of 150 patients who had diabetes were included. Cronbach's alpha was calculated to assess the reliability. Results: According to the recommended scoring method, the Mean ± SD of MMAS-8 scores was 4.97 ± 1.92. Good internal consistency was found in our study (Cronbach's α = 0.70). Not any significant relationship between MMAS-8 categories and occurrence of complications was found. Conclusions: The findings of this validation study indicate that the Persian version of the MMAS-8 is a reliable measure of medication adherence, but it has not acceptable validity. Further studies are needed to reach a good validity.

Diagnostic accuracy of apparent diffusion coefficient (ADC) value in differentiating malignant from benign solid liver lesions: a systematic review and meta-analysis.

OBJECTIVES: We undertook a systematic review and meta-analysis of the diagnostic performance of mean apparent diffusion coefficient (ADC) values derived by diffusion-weighted (DW)-MRI in the characterization of solid benign and malignant liver lesions, and to assess their value in discriminating these lesions in daily routine practice. METHODS: A systematic review of PubMed, Embase, Scopus, and Web of Science was conducted to retrieve studies that used ADC values for differentiating solid benign/dysplastic nodules and malignant liver lesions. A bivariate random-effects model with pooled sensitivity and specificity values with 95% CI (confidence interval) was used. This meta-analysis was performed on the per-lesion basis. Summary receiver operating characteristic (SROC) plot and area under curve (AUC) were created. RESULTS: A total of 14 original articles were retrieved. The combined (95% CI) sensitivity and specificity of mean ADC values for differentiating solid benign from malignant lesions were 78% (67-86%) and 74% (64-81%), respectively. The pooled (95% CI) positive and negative LRs were respectively 3 (2.3-3.8) and 0.3 (0.21-0.43). The DOR (95% CI) was 10 (7-15). The AUC (95% CI) of the SROC plot was 82% (78-85%). Reporting bias was negligible (p value of regression test = 0.36). Mean size of malignant lesions and breathing pattern of MRI were found to be sources of heterogeneity of pooled sensitivity. CONCLUSION: ADC measurement independently may not be an optimal diagnostic imaging method for differentiating solid malignant from solid benign hepatic lesions. The meta-analysis showed that ADC measurement had moderate diagnostic accuracy for characterizing solid liver lesions. Further prospective and comparative studies with pre-specified ADC thresholds could be performed to investigate the best MRI protocol and ADC threshold for characterizing solid liver lesions. ADVANCES IN KNOWLEDGE: ADC measurement by DW-MRI does not have a good diagnostic performance to differentiate solid malignant from solid benign lesions. Therefore, we suggest not using ADC values in clinical practice to evaluate solid liver lesions.

Health technology assessment of image-guided radiotherapy (IGRT): A systematic review of current evidence.

BACKGROUND: Image-guided radiotherapy used multiple imaging during the radiation therapy course to improve the precision and accuracy of health care provider's treatment. OBJECTIVES: This study aims to assess the safety, effectiveness and economic aspects of image-guided radiation therapy for decision-making about this technology in Iran. METHODS: In this study, the most important medical databases such as PubMed and Cochrane Library were searched until November 2014. The systematic reviews, health technology assessment reports and economic evaluation studies were included. The results of included studies were analyzed via the thematic synthesis. RESULTS: Seven articles were included in the study. The results showed that image-guided radiation therapy, regardless of the imaging technique used in it, is associated with no major toxicity and has the potential to reduce the symptoms of poisoning. Using image-guided radiation therapy for prostate cancer resulted in substantial improvement in the quality of the received dose and optimal therapeutic dose of radiation to the targeted tumor while the radiation dose to the surrounding healthy tissues was minimal. Additionally, image-guided radiation therapy facilitated the diagnosis and management of exception deviations, including immediate changes and gross errors, weight loss, significant limbs deformity, systematic changes in the internal organs and changes in respiratory movements. Usage of image-guided radiation therapy for prostate cancer was associated with increased costs. CONCLUSION: Current available evidence suggests that the image-guided radiation therapy can reduce the amount of radiation to healthy tissue around the tumor and the toxicity associated with it. This can enhance the safe dose of radiation to the tumor and increase the likelihood of destruction of tumor. The current level of evidence required conducting further studies on the costs and effectiveness of this technology compared with conventional technology.