Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, the increased mortality risk of patients with underlying cardiovascular diseases and COVID-19 was raised. Besides, coronavirus itself enhances the incidence of myocardial injury, which suggests a two-sided relation. We aimed to discuss the role of COVID-19 in the progression of stable coronary artery disease (CAD) to acute coronary syndrome (ACS), which might lead to a greater rate of out-of-hospital cardiac arrest and a higher fatality rate of ACS during the pandemic. We briefly reviewed several mechanisms in this regard: Systemic inflammation and cytokine release in critical patients; Plaque rupture and coronary thrombosis; Dysregulation of cytotoxic T-cell lymphocytes; Malignant ventricular arrhythmias. We reinforce applying more attention to COVID-19 patients with stable CAD during follow-up to prevent progression to ACS. These individuals should seriously observe World Health Organization protocols to avoid virus transmission by carriers.
Genitourinary (GU) cancers are a class of diseases defined by anatomical and physiological origin. Nevertheless, they vary in approximately any characteristics of molecular and cellular biology, pathophysiology, treatment in advanced stages, and prognosis. Prostate cancer is the most frequent GU malignancy, with a moderately indolent behavior, a tendency for bone metastases, and a dependency on the androgen receptor pathway, for which has been successfully accomplished treatments. Kidney cancer is accompanied by several paraneoplastic, metabolic, and hormonal syndromes. Bladder/urothelial cancers, regrettably, are the subgroup of neoplasms with quite a little advancement in therapeutic opportunities for metastatic disease. However, a few patients can be treated with combination chemotherapy, particularly in metastases with small volumes restricted to lungs or lymph nodes. Testicular cancer is treatable even in extensively disseminated conditions of disease, mainly with cisplatin-based combination chemotherapy. Major female GU cancers include the cervix, corpus uterine, and ovarian cancer, in descending order regarding incidence rate. GU cancer patients need to be treated with a multidisciplinary approach. Patients with metastatic conditions have traditionally been cured with a combination of chemotherapies and targeted medicines. These cytotoxic drugs achieve palliation and have high response rates; nevertheless, complete responses are uncommon. In the last 20 years, the science of cancer immunology has advanced rapidly. A variety of medicines and vaccines have recently been produced that adjust the immune system to recognize and target cancer cells. These drugs have two advantages: they improve the body's immune system's ability to combat cancer and have fewer side effects than traditional cytotoxic chemotherapy. Second, a small but significant proportion of patients with metastatic illness are cured or experience long-term responses after receiving immunotherapy. In this chapter, we clarify the fundamental aspects of GU cancers with an interdisciplinary approach focusing on new diagnosis and treatment strategies and future aspects.
Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10-24 years during the past three decades.Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10-14, 15-19, and 20-24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019.In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31·1 million DALYs (of which 16·2 million [52%] were transport related) among adolescents aged 10-24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34·4% (from 17·5 to 11·5 per 100 000) for transport injuries, and by 47·7% (from 15·9 to 8·3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80·5% to 42 774 for transport injuries and by 39·4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010-19, the rate per 100 000 of transport injury DALYs was reduced by 16·7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48·5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0·2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010-19.As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low-middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury.Bill & Melinda Gates Foundation.
Introduction and objectives: Severe combined immunodeficiency (SCID) is a subset of primary immunodeficiency diseases caused by a hereditary deficiency of the adaptive immune system. Mutation in recombination activating gene (RAG) is known as the underlying genetic cause of SCID. RAG protein plays a pivotal role in V(D)J recombination which is the main process to assemble lymphocyte antigen receptors during T- and B-cell development. The patients are characterized by recurrent infections, failure to thrive, chronic diarrhea, and fever, in early infancy. Herein, we present a case of SCID with rare neurological manifestations affected by a mutation in RAG1.Patients and methods: The patient was a 15-month-old infant born to a consanguineous family. She was presented with neurological abnormalities including facial nerve palsy, seizure, and decreased consciousness. Next-generation sequencing (NGS)-based primary immunodeficiency disease (PID)-gene panel screen and Sanger sequencing were performed to identify the genetic mutation.Results: We found a novel homozygous missense mutation in RAG1, c.1210C>T,p.Arg404Trp, which was predicted to be deleterious (combined annotation dependent depletion, CADD score of 27.4). Both parents were heterozygous carriers for this mutation. According to her laboratory data, both T cell and B cell numbers were decreased and the patient was diagnosed as RAG1- SCID.Conclusions: SCID is a pediatric emergency with a variety of manifestations in infants. Therefore, accurate diagnosis importantly in the case of rare manifestations must be considered in these patients. Our findings point toward the importance of genetic assessment for early diagnosis and timely treatment of this disorder.
Coronavirus disease reached pandemic proportions at the beginning of 2020 and continues to be a worldwide concern.End organ damage and acute respiratory distress syndrome are the leading causes of death in severely or critically ill patients.The elevated cytokine levels in severe patients in comparison with mildly affected patients suggest that cytokine release syndrome (CRS) occurs in the severe form of the disease.In this paper, the significant role of pro-inflammatory cytokines, including IL-1, IL-6, and TNF-alpha, and their mechanism of action in the CRS cascade is explained.Potential therapeutic approaches involving anti-IL-6 and anti-TNF-alpha antibodies to fight COVID-19 and reduce mortality rate in severe cases are also discussed.Key words: Corona virus,
Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050.
Considering the difficulties of differentiating Parkinson's disease (PD) from drug-induced Parkinsonism (DIP) in patients receiving antipsychotics, developing robust diagnostic tools is essential. Herein, we used the metaiodobenzylguanidine (MIBG) scan to assess its diagnostic accuracy for this purpose.44 DIP patients and 32 patients with PD as controls were enrolled. All the participants underwent a cardiac 131I-MIBG scan. Statistical analysis was conducted to determine the significance of the results, and accuracy analyses were conducted to calculate the related sensitivity and specificity of the MIBG scan.The mean age of PD and DIP groups were 62.6 ± 5.9 and 51.5 ± 10.8 years, respectively. The mean duration of drug consumption in the DIP group was 52.2 ± 29.4 days (the mean interval between drug initiation and DIP onset was 28.5 ± 20.5). Symptoms relief occurred 40 ± 24.2 days after drug discontinuation. In the PD group, 15.6% showed negative and 84.4% positive results on the MIBG scan. In the DIP group, 86.4% were negative, and the remaining were positive. The difference in MIBG uptake between the two groups was statistically significant (P-value < 0.001). The sensitivity and specificity of the MIBG scan were 84.4% (CI: 84.0-84.8) and 86.36% (CI: 86.0-86.7) for the diagnosis of PD, respectively.Our results indicated more positive MIBG scans in the PD group than the DIP. Also, the MIBG scan's sensitivity and specificity in differentiating the PD are acceptable. Future works should assess these findings and the role of the MIBG scan in prognosis assessment of DIP and better allocation of the patients to related disciplines.
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