Metallography

Abstract Background Classic Philadelphia-negative myeloproliferative neoplasms (MPNs), such as polycythemia vera (PV), essential thrombocythemia (ET), and myelofibrosis (MF), are defined by the unregulated production of bone marrow components resulting from the clonal expansion of multipotent bone marrow progenitors. Thrombotic complications represent a major cause of morbidity and mortality in BCR-ABL-negative MPNs. Multiple factors have been identified as potential contributors to thromboembolism in MPN patients, yet the exact pathophysiology remains poorly understood. Also, the current risk stratification systems lack early predictors of thromboembolic risk, mandating the need to identify new surrogate thrombotic markers. Despite the use of cytoreductive therapy and antithrombotic drugs, unfortunately, the incidence rate of thrombosis remains high, which advocates for further research to discover novel antithrombotic therapeutic targets. Protein disulfide isomerase (PDI), an endoplasmic reticulum protein that is critical for protein folding, is released by stimulated platelets and endothelial cells and was found to play a regulatory role in thrombosis. Inhibitors of PDI have been shown to prevent thromboembolic events in cancer patients. We aimed to study the PDI level in MPN patients and assess its role as a marker of increased thromboembolic risk in MPN patients, which might shed light on a new area of investigation in the prognosis and prevention of thromboembolism in MPN patients. Methods This is a case–control study where we investigated the serum level of PDI in a cohort of MPN patients in comparison to a control group. Serum PDI level was measured using ELISA to assess if PDI level is pathologically elevated in MPN patients; we also correlated the PDI level with either history/recent thrombotic events or the presence of silent thrombosis screened for by venous and arterial duplex. Results PDI levels were found to be pathologically elevated in MPN patients when compared to the control group. As a secondary outcome, we aimed to correlate the level of PDI to different clinical and imaging parameters, but no significant association could be found. Conclusion PDI may have a possible role in the underlying pathogenesis of thrombotic events in Philadelphia-negative MPN patients and may have a role in predicting a higher risk of developing thromboembolic events, and this may shed light on the possible future use of PDI as a therapeutic target for prevention of thrombosis in MPN patients.

Abstract Background Hyperacute ischemic stroke is a type of ischemic stroke that occurs rapidly and suddenly due to blockage of blood flow to the brain, with onset within 0–24 h. The recommended treatment for hyperacute ischemic stroke patients is a recombinant tissue plasminogen activator (rtPA) according to the guidelines of the American Heart Association/American Stroke Association (AHA/ASA) and the European Stroke Organization (ESO). In Indonesia, there is still limited adoption of intravenous thrombolysis, and the researchers hope that hospitals in Indonesia will adopt this treatment for managing hyperacute ischemic stroke patients. Objective This study aims to describe the clinical characteristics of hyperacute ischemic stroke patients treated with intravenous thrombolysis. Methods This descriptive cross-sectional study was conducted at Dr. Hasan Sadikin Hospital in Bandung, which serves as the referral hospital for West Java for stroke cases treated with intravenous thrombolysis. The study employed total sampling from January 2021 to March 2024. Results From 23 patients, we found that most hyperacute ischemic stroke patients treated with intravenous thrombolysis were in the late elderly age group, 56–65 years old (43.5%), with onset within ≤ 4.5 h. Of the total sample, 91.3% of patients did not experience complications and approximately 50% of patients have good clinical and functional outcomes (based on NIHSS score). Conclusion This demonstrates the effectiveness of intravenous thrombolysis in managing hyperacute ischemic stroke patients. Future research should continue to explore optimal patient selection criteria and refine treatment protocols to further improve outcomes in stroke management.

Abstract Graphical Abstract

Abstract Background and aim Dengue fever is a mosquito-borne viral disease that has been recently increasing in incidence in Iran. Understanding the factors contributing to this outbreak is crucial in order to implement effective control measures. The aim of this study was to review the recent outbreak of dengue fever in Iran and identify the contributing factors. Methods A systematic search of databases, including PubMed, Web of Science, Scopus, Google Scholar, and SID, was conducted to identify relevant studies on dengue fever in Iran from 2010 to 2024. The quality of the studies was assessed using the Critical Appraisal Skills Program (CASP) tool. Results The review revealed a significant increase in the number of dengue fever cases in Iran in recent years, with outbreaks occurring in different regions of the country. The recent outbreak of dengue fever in Iran has been mainly attributed to factors such as increased travel to dengue-endemic regions, climate change, inadequate mosquito control measures, and lack of public awareness. The outbreak has been particularly severe in cities with high population densities and poor sanitation. Conclusion The recent outbreak of dengue fever in Iran indicates the need for improved mosquito control measures, increased public awareness, and better surveillance systems. In Iran, preventive measures for dengue fever include eliminating standing water, using mosquito repellent, wearing protective clothing, installing screens, using mosquito nets, seeking medical attention, and staying informed.

Abstract We present a case of a 23-year-old woman who developed afebrile left-sided sacroiliitis and tricuspid valve endocarditis caused by Staphylococcus aureus, one week after experiencing a bout of diarrhea. The patient presented with bilateral lower extremity weakness and left sacroiliac joint pain, without fever. Diagnostic workup, including laboratory tests, imaging studies, and synovial fluid analysis, confirmed the diagnosis of S. aureus septic arthritis. The patient subsequently developed tricuspid valve endocarditis, diagnosed by transthoracic echocardiography. Management involved a prolonged course of intravenous clindamycin, as the patient had an allergic reaction to vancomycin. This case highlights the importance of considering infectious etiologies in patients presenting with musculoskeletal complaints, even in the absence of fever, and underscores the potential for hematogenous spread of infection from one site to another. Further research is needed to elucidate the pathophysiological mechanisms underlying afebrile presentations of serious infections and to identify risk factors for atypical clinical manifestations.

Abstract Objectives This study aimed to evaluate the urinary level of soluble CD163 (sCD163) in patients with type 2 diabetes as a potential early indicator of diabetic nephropathy (DN). Methods This cross-sectional study included 60 type 2 diabetic patients and 20 healthy individuals. Patients were divided into three groups according to their albumin/creatinine ratio: normoalbuminuric, microalbuminuric, and macroalbuminuric groups. Urinary levels of sCD163 (usCD163) were measured using ELISA. Results The mean CD163 levels showed a significantly increasing trend from the patients without nephropathy to those with nephropathy. The multivariate logistic regression analysis revealed that CD163 was an independent risk factor for DN progression in patients with DM (p = 0.011). According to the ROC curve, at a cutoff value of CD163 > 510.2 pg/mL, the area under the curve was 0.88 for discriminating diabetic patients with DN from those without. Conclusions sCD163 can be used as a potential marker for prediction of DN in patients with type 2 diabetes.

Abstract Background Endoscopic management of gastric antral vascular ectasia (GAVE) is challenging. Most of the published studies investigated the role of argon plasma coagulation (APC). However, comparing APC versus endoscopic band ligation (EBL) is still underestimated. Therefore, this study aimed to evaluate and compare efficacy and safety of EBL and APC in management of GAVE. Methods Between April 2022 and April 2024, a randomized, controlled study was conducted in EL-Rajhi endoscopy unit at Assuit university hospital to enroll all patients endoscopically diagnosed with GAVE. Each patient was randomly assigned to his group using quick Calcs method for randomization. Post-procedure follow-up after 3 months and 6 months to evaluate potential complications. Results A total of 30 patients diagnosed endoscopically with gastric GAVE were randomly divided into two groups: APC group including 16 patients (62.5% males and 37.5% females), their median age was 64.00, and EBL group including 14 patients (71.4% males and 28.6% females), their median age was 65.00. We found that both EBL and APC were effective in successful management of GAVE and improving hemoglobin level (p < 0.001) and decreased the need for blood transfusion with no statistically significant difference between the two groups (p 0.732). However, EBL was superior to APC in fewer number of endoscopic sessions needed for endoscopic remission of GAVE (p < 0.001). There were no significant differences in complications between the two groups (p > 0.056). Conclusion APC and EBL are effective in the management of GAVE. However, EBL is potentially superior in fewer number of treatment sessions, but not in the extent to which the two methods improved hemoglobin level and blood transfusion needed. Further studies with large numbers, different inclusions are needed.

Abstract Behçet’s disease (BD) is a rare systemic vasculitis with multi-organ involvement, including infrequent arterial complications. We report a case of a 20-year-old male who presented with a renal spontaneous hematoma, leading to the diagnosis of BD. This rare manifestation underscores the importance of considering BD in young patients with unexplained vascular issues. Early diagnosis and appropriate management are crucial for better outcomes.

Abstract Background Irritable bowel syndrome (IBS) is a prevalent yet intricate gastrointestinal condition that poses substantial challenges in both diagnosis and treatment. The lack of definitive diagnostic markers and the focus on symptom-based therapies often result in inadequate relief for patients, leading to frustration and psychological distress. In areas where access to healthcare is limited, the uncertainty surrounding IBS frequently drives patients to explore alternative treatments, including traditional medicine, which can potentially worsen the condition or introduce new health risks. Aim This case report study aimed to examine the underappreciated role of exercise as a viable treatment for IBS, shedding light on the shortcomings of current diagnostic and therapeutic practices. It provides an important perspective on the diagnostic and treatment challenges of IBS and presents exercise as a highly effective non-pharmacological intervention that is often underutilized in clinical practice in Ethiopia.

Abstract Background Egypt has one of the largest populations in the Middle East and North Africa. With the help of mathematical models that project the situation over the next several years, this research seeks to understand the current epidemiologic condition of malignancies in Egypt. This may highlight the predicted burden of different cancers and guide policy makers in finding solutions to reduce such a burden. Methods We used the Global Cancer Observatory (GLOBOCAN)-2020 database of Egypt for our statistical analysis. Power law was used to find the causal relationship between the number of new cases and deaths. In order to determine the severity of the disease, cancer rank was examined and used to shed light on potential cancer-related characteristics. Equations comparing the state of various cancers were used to correlate the number of new cases and fatalities. Results When compared to the average global statistics, Egypt had alarmingly high death rates from breast and liver cancer. Additionally, the increase in newly reported cases was linked to an increase in mortality that happened more quickly than the global average rates. Liver cancer was first in newly reported cases and deaths, followed by breast and bladder cancers. Liver and pancreatic malignancies have the highest ranks as the most fatal cancers in Egypt. Conclusion In Egypt, despite the efforts exerted by health authorities aiming at the early detection of different cancers, the country still occupies a high rank in cancer deaths compared to other countries, which is expected to continue for the coming few years.

Abstract Background In recent years, there has been growing awareness of metabolic dysfunction-associated steatotic liver disease (MASLD) linked to hypothyroidism. However, insufficient data exists on how levothyroxine (LT4) replacement therapy impacts MASLD. We aimed to assess the effects of LT4 treatment on dyslipidemia and MASLD in patients with subclinical hypothyroidism (SCH). Methods In a randomized, controlled study, 230 patients with MASLD were screened for SCH, and 182 were diagnosed with SCH. Of these, 30 had significant SCH and 152 had mild SCH. All patients with significant SCH received LT4 therapy (significant SCH-LT4), while those with mild SCH were divided into two groups: 50 received LT4 treatment (mild SCH-LT4) and 102 did not (mild SCH-control). Results Significant improvements in hepatic steatosis severity were observed in the treated groups compared with the control. After LT4 treatment, MASLD prevalence decreased to 50% (p = 0.001) in the significant SCH-LT4 group and to 60% (p = 0.025) in the mild SCH-LT4 group. In the mild SCH-control group, MASLD prevalence improved slightly but non-significantly from 100 to 75% (p = 0.164). Compared to other groups, the significant SCH-LT4 group showed greater improvements in metabolic parameters, including weight, body mass index, total cholesterol, high-density lipoprotein cholesterol, and C-reactive protein, emphasizing the notable impact of levothyroxine. Conclusion This study highlights that LT4 treatment can significantly improve MASLD, dyslipidemia, and systemic inflammation in MASLD patients with SCH, particularly in those with significant SCH. These findings support the clinical use of thyroxine for managing MASLD and dyslipidemia in SCH patients.

Abstract Introduction Patients with end-stage kidney disease (ESKD) need ongoing dialysis treatments or a kidney transplant to survive. Kidney transplantation is the optimal treatment for patients with ESKD. Advances in surgical, immunosuppressive, and monitoring protocols have led to a significant improvement in short-term kidney allograft survival. However, in order to avoid rejection, kidney transplant patients have to be on immunosuppression which increases the risk of infections, malignancies, cardiovascular diseases, and many other complications. So a balance has to be struck to prevent under or over-immunosuppression. In this study, we present our experience and follow-up data of kidney transplantations done at our center with special emphasis on the incidence of complications and outcomes in recipients at 1 year. Aims and objectives 1. To estimate the incidence of post-transplant complications in live kidney transplant recipients at 1 year. 2. To assess the patient and graft survival at 1 year in live kidney transplant recipients. Materials and methods This observational study was done in the Department of Nephrology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, J&K. Patients who underwent transplant at our center from April 2022 to April 2023 were included and each patient was followed up for 1 year in this study. All the consenting kidney transplant recipients undergoing kidney transplantation at our center during the study period were included. Results A total of 45 kidney transplants were included in the study. The mean age of our study population was 31.2 years (SD 10.5). 77.5% of our recipient population comprised of men and 22.5% were women. The mean dialysis vintage was 15.1 months (SD 9.4). The incidence of biopsy-proven acute rejection was 15% while 1 year patient and graft survival were 100% and 95%, respectively. The incidence of BK virus-associated nephropathy was 10%. The overall incidence of other infections was 37.5%. The incidence of hypertension and post-transplant diabetes was 65% and 15%, respectively. The incidence of anemia and erythrocytosis was 12.5% and 22.5%, respectively. Conclusion Kidney transplant is the treatment of choice for ESKD. However, these patients are at risk of infectious, malignant, cardiometabolic, and other complications. Heightened awareness and surveillance is of utmost importance in these patients.

Abstract Background Hepatitis B remains a major health burden with perinatal transmission being a key concern in endemic regions in countries like Nigeria. Vaccination is critical but the 5–10% non-response rate necessitates research into biomarkers like IL-6 that may predict immunogenicity. This study assessed hepatitis B vaccine response and the role of IL-6 in vaccinated individuals in Specialist Hospital, Sokoto State, Nigeria. Methods This cross-sectional study quantified IL-6 and hepatitis B surface antibody (HBsAb) levels in 50 vaccinated subjects in Sokoto, Nigeria, using ELISA and chemiluminescence immunoassays. Sociodemographic data including age, gender, and vaccine route were collected via questionnaires. Correlation analysis was performed between IL-6 and HBsAb levels to assess vaccine response prediction potential. Results Among the 50 participants, 84% demonstrated seroprotection based on adequate HBsAb titers, confirming the effectiveness of vaccination programs. However, 16% remained insufficiently immunized despite vaccination, highlighting interindividual variability warranting further investigation. IL-6 levels were predominantly normal (92%) with few (8%) exhibiting low levels, indicating appropriate inflammatory regulation overall. No sociodemographic factors emerged as significant predictors. A non-significant (p = 0.354) negative correlation (r = − 0.134) was found between IL-6 and HBsAb, suggesting IL-6 may not strongly predict hepatitis B vaccine response. Conclusion While protection rates align with WHO benchmarks, non-responders indicate a need to uncover immune and genetic mechanisms influencing vaccine outcomes through larger studies. The negative IL-6/HBsAb correlation warrants further analysis given IL-6’s regulatory role.

Abstract Background The potential clinical value of early screening of celiac disease (CD), among patients with Graves’ disease (GD) at various clinical stages has not been determined precisely. Prevalence and confirmatory tests of CD in newly diagnosed GD are still debatable. We tracked the diagnostic markers of CD in patients with GD at the time of diagnosis and after control of hyperthyroidism. Methods Our study included 40 patients newly diagnosed with GD, who had undergone laboratory, ophthalmology, and radiology examinations. We screen patients for endomysial antibody (EMA-Ab), tissue transglutaminase antibody (tTG-Ab), and IgG and IgA antigliadin antibodies (AGA-IgG and AGA-IgA) initially and after confirmed euthyroid state with antithyroid treatment with small intestinal biopsy for histopathology for patients with persistent seropositive antibodies. Results Initially, out of all 40 GD patients who underwent screening, the prevalence of positive AGA-IgA was (17.5%, n = 7/40), AGA-IgG (30%, n = 12/40), EmA-Ab (5%, n = 2/40), and IgA-tTG was (7.5%, n = 3/40). While baseline positive tTG-Ab persisted in only two patients, baseline positive AGA-IgA, AGA-IgG, and EmA-Ab were converted to negative when patients achieved euthyroid state. Thyroid function tests showed significant differences before and after treatment (P < 0.001). Conclusion Seropositivity for CD during the active phase of Graves’ hyperthyroidism should be confirmed with clinical and histopathological stigma after control of hyperthyroidism.