Tehran University Medical Journal

Comparison of the effectiveness of three drugs, rosuvastatin, atorvastatin, and simvastatin, on lipids using network meta-analysis: a meta-analysis study

Kourosh Sayehmiri

Background: One of the main causes of death in the world is cardiovascular disease. While there is no denying that lipids play a risk factor in cardiovascular disease, statins are effective medications for treating this condition. We used network meta-analysis to compare the impact of three drugs atorvastatin, simvastatin, and rosuvastatin on lipids.
Methods: Type of study of this research was a systematic review and network meta-analysis. Databases such as Scopus, PubMed, ISI, Science Direct, Google Scholar, SID, MagIran, web of Science, and Cochrane Library were searched. Keywords atorvastatin, simvastatin, and rosuvastatin were used in the search strategy. We did both standard meta-analyses and network meta-analyses. Consistency was checked by comparing direct and indirect effect sizes. The time period for searching articles was from 2000 to June 2024. All relevant articles published in English or Persian were reviewed. Paired wised comparisons were made using the intervalplot command in STATA. The surface under the cumulative ranking (SUCRA) was used to rank the efficacy of treatments. The Q test and I2 index were used to assess the heterogeneity of the studies. Data were analyzed using STATA Ver. 17.
Results: From the 61 articles that were included in the network meta-analysis (atorvastatin 43 studies, rosuvastatin 22 studies, simvastatin 21 studies, and placebo 15 studies). The total sample size was 62178 patients. The results showed that the effect of, atorvastatin, rosuvastatin, and simvastatin with placebo on fat lipids was significant (P<0.001). Still, there was not a substantial difference between the effects of the three drugs. The best treatment for reducing LDL was atorvastatin (standard mean difference (SMD) =-5.18, 95% confidence interval (CI);-7.42,-2.95, P<.001). SMD LDL for rosuvastatin and simvastatin were -4.35(95% CI; -6.81,-1.89), and -3.44(95% CI;-5.89,-.98) respectively. The surface under the cumulative ranking (SUCRA) showed that the probability that Rosuvastatin was the best drug for reducing triglycerides was 82.4% and the likelihood that atorvastatin was the best drug for reducing cholesterol was 80.3%.
Conclusion: Atorvastatin, rosuvastatin, and simvastatin have a better effectiveness than placebo in reducing fat lipids. Atorvastatin was the best treatment to reduce LDL, and TC and increase HDL. Rosuvastatin was the best drug to reduce TG. Atorvastatin, rosuvastatin, and simvastatin were the effective treatments to reduce fat lipids respectively.

Correlation of radiomics features extracted from nuclear medicine images with lesion metabolism in patients with colon cancer

Peyman Sheikhzadeh

Background: Nuclear medicine imaging has shown high accuracy in evaluating the metabolism of colon cancer lesions. The aim of this study was to investigate the ability of radiomics features extracted from nuclear medicine images as non-invasive biomarkers of lesion metabolism in patients with colon cancer by examining the correlation of these features with SUV (standardized uptake value) max values.
Methods: The current study was a cross-sectional study that was conducted from July 2022 to July 2023 in the nuclear medicine department of Tehran University of Medical Sciences. In this study, PET/CT (positron emission tomography/computed tomography) images of 60 patients with primary colon cancer were used. Colon cancer lesions were manually delineated on PET images by an experienced physician and saved as VOIs (volumes of interest). Thirty-two textural radiomics features were extracted from each VOI, including feature groups of gray-level co-occurrence matrix (GLCM), gray-level run-length matrix (GLRLM), neighborhood grey-level difference matrix (NGLDM), and gray-level zone length matrix (GLZLM). Then, the correlation of these features with SUVmax values was investigated using the Spearman correlation coefficient statistical test. Also, the value of p<0.05 was considered as the significance level of the test.
Results: A comprehensive analysis revealed that more than 96% of the examined radiomics features specifically, 31 out of 32 exhibited a statistically significant correlation with lesion metabolism values, as indicated by p-values less than 0.05. Among these features, GLZLM_HGZE stood out with a high correlation coefficient of 0.9881, alongside a significance level of less than 0.0001. Similarly, GLZLM_SZHGE also demonstrated a strong correlation, with a coefficient of 0.9723 and a significance level below 0.0001, indicating a robust relationship with SUVmax values. In contrast, GLZLM_LZHGE was the only feature that failed to show a significant correlation with lesion metabolism values (p>0.05).
Conclusion: The radiomics method has the potential to be used as a completely non-invasive method to evaluate the metabolism of colon cancer lesions and facilitate the monitoring and treatment of patients with colon cancer.

Relationship between sarcopenia and postoperative complications in bladder cancer patients undergoing radical cystectomy

Mohsen Shiraghaei

Background: Sarcopenia is the degenerative loss of skeletal muscle mass, which is known as a poor postoperative outcome in various cancer types. Radical cystectomy (RC) is often associated with high mortality rates, and sarcopenia is hypothesized to aid in risk stratification. Hence, this study assessed the role of Sarcopenia as an indicator of postoperative outcomes and survival rates in patients undergoing RC for bladder cancer.
Methods: This cross-sectional research was carried out between January 2022 and January 2023 on 30 patients with bladder cancer who were candidates for RC and referred to the urology clinic of Imam Khomeini Hospital in Tehran. One week before surgery, the cross-sectional area of the psoas muscle was measured using MRI to estimate muscle volume, and the sarcopenia index was calculated. Muscle area evaluation was performed by calculating the cross-sectional area of the left and right psoas muscles on MRI. The psoas muscle area was calculated by excluding blood vessels, bony structures, and intermuscular fat regions based on fat signals. The calculated psoas muscle area was then normalized to the patient's height in square meters. To improve the quality of reporting on surgical complications, the patients were re-examined and the duration of patients' hospital stays was measured.
Results: The mean sarcopenic index for the patients was 1264.6 ± 591.5 mm²/m². Seven patients (24.1%) were smokers, while 22 patients (75.9%) were non-smokers. During the 10-month follow-up period, 25 patients (83.3%) remained alive, and 5 patients (16.7%) passed away. The mean value of sarcopenic index in patients with localized cancer was higher than those with advanced cancer, but this difference was not statistically significant. Data analysis revealed a significant association between higher mortality rates and the presence of locally advanced bladder tumors (P = 0.046). Additionally, a reduced sarcopenic index in this study was significantly correlated with lymphovascular invasion. In this study, no correlation was found between perioperative complications and sarcopenic index.
Conclusion: To conclude, a significant association was observed between a reduction in the sarcopenic index and lymphovascular invasion; however, no connection was identified between mortality rates and postoperative complications following RC.

Investigating the effect of empagliflozin on renal function index and the level of hemoglobin A1c (HbA1c) in patients with type 2 diabetes

Fatemeh Hayati

Background: Diabetic kidney disease is a common complication of diabetes and the most common cause of end-stage kidney disease worldwide. Empagliflozin is associated with slower progression of kidney disease and a lower incidence of kidney complications. So, the aim of the study is to compare renal outcomes in type 2 diabetic patients with and without empagliflozin.
Methods: This research is a cross-sectional study based on the information contained in the files of patients referred to Imam Khomeini and Golestan hospitals in Ahvaz in 1400-1401. Inclusion criteria included age over 18 years, type 2 diabetes, HGA1c less than or equal to 9, GFR between 30 and 60 ml/min/1.73 m2, use of empagliflozin for more than or equal to three months, and urinary albumin to creatinine ratio greater than 30 mg/dL. Exclusion criteria included patients not attending the clinic for follow-up during the study, proteinuria due to glomerulonephritis, type 1 diabetes, vaginitis, UTI, and liver failure based on history.
Based on this, 136 people with type 2 diabetes were included in the study and were randomly divided into two drug and control groups, one group of patients who took empagliflozin for three months and the other group of patients who did not receive this treatment. Patient data, including serum creatinine, HBA1C, albuminuria, weight, blood pressure, side effects, were extracted and then the patients' data were collected three and six months after receiving empagliflozin. Data analysis was done with descriptive and analytical statistics.
Results: In this study, 56 (41.2%) were male and 80 (58.8%) were female. Changes in eGFR (P=0.044) and (P=0.003), HbA1C (P=0.014), albuminuria (P=0.001) during 3 months and 6 months, and changes in systolic blood pressure (0.020) during 3 months between the empagliflozin group were significantly different compared to the control group. However, there was no significant difference between the two groups in terms of weight changes during 3 months and 6 months (P=0.97) and changes in systolic blood pressure during 6 months (P=0.13).
Conclusion: Using empagliflozin can improve kidney function and reduce albuminuria.

Comparison of quality of life between diabetic patients with and without retinopathy: an analytical cross-sectional study in Jahrom city

Navid Kalani

Background: Diabetic retinopathy is one of the main causes of blindness in the world and one of the causes of disability in diabetic patients. However, no study has been conducted in Iran to Comparison of Quality of Life between Diabetic Patients With and Without Retinopathy.
Methods: This descriptive-analytical study was conducted on 183 diabetic patients referred to the Jahrom Honari Clinic from October to February 2023. The patients were divided into two groups: diabetic patients without retinopathy complications and diabetic patients with retinopathy complications. The data collection tool included two demographic information questionnaires and a quality of life questionnaire (DQOL-BCI). The data of the two groups and subgroups were compared and analyzed using SPSS version 21 software and descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistical tests (chi-square, t-test, ANOVA, Pearson correlation coefficient) at a significance level of P<0.05.
Results: The majority of diabetic patients participating in the study in the group with retinopathy (70.3%) and the group without retinopathy (75%) were male. The groups of Diabetic Patients With and Without Retinopathy did not differ significantly from each other in terms of demographic variables and were similar. There was a significant difference between Diabetic Patients With and Without Retinopathy in terms of average quality of life (P>0.001). The mean quality of life in the group of diabetic patients with retinopathy (41.19±7.97) was higher than that of the group of diabetic patients without retinopathy (37.22±7.37). There was no significant difference between the mean quality of life and demographic variables in diabetic patients without retinopathy and diabetic patients with retinopathy (P<0.001).
Conclusion: That patients with retinopathy had a higher quality of life than the group without retinopathy. These results were obtained while none of the demographic variables such as age, gender, marital status, and education level had a significant relationship with the quality of life of these patients.

Evaluation of the results of renal biopsy performed on diabetic patients referred to Imam Khomeini and Golestan Hospitals of Ahwaz, southwest Iran

Maryam Khombi Shooshtari

Background: Diabetic nephropathy is one of the most important complications of diabetes worldwide. In diabetic patients, although renal biopsies performed with less frequency, it is important because these patients may have glomerular disorders other than diabetic nephropathy. Therefore, in this study, we investigated the results of renal biopsies performed on diabetic patients referred to diabetic clinics in Imam Khomeini and Golestan hospitals in Ahvaz, southwest Iran.
Methods: In this descriptive-cross-sectional study, information related to biopsy samples from 67 patients recognize with diabetes who underwent renal biopsy from August 2103 to September 2018, collected and recorded retrospectively. The presence of diabetic nephropathy and other renal diseases was confirmed by pathological evaluation of all renal biopsy specimens. Then, the data were analyzed by using SPSS 20 software.
Results: The results of this study presented that diabetic nephropathy (67.2%), diabetic nephropathy along with acute tubulointerstitial nephritis (7.5%), acute tubulointerstitial nephritis (6%) and membrane glomerulonephritis (6%) were the most frequent diagnosis in diabetic patients with renal disorder. Furthermore, in the described cases, class IV (47.9%), III (35.4%) and II (12.5%) and I (4.2%) were the most common classes of nephropathy, respectively. Interestingly, there was no significant association between age, sex, proteinuria and hematuria with the frequency of nephropathy in the patient who underwent renal biopsy. Also, in this study, the frequency of class I and II nephropathy was 100% in patients older than 50 years, while 64.7% of class III was in patients under 50 years of age, which was also statistically significant (P=0.018). On the other hand, in the studied patients, there were not significant different between the frequency of diabetic nephropathy class and proteinuria, azotemia, and hematuria (P>0.05).
Conclusion: According to the obtained results, to reduce the risk of complications and costs, it seems crucial to be more wary in pick out diabetic patients for renal biopsy and to enhance the threshold of renal biopsy in diabetic patients as much as possible.

Epidemiological investigation of emergency department visits in patients with cancer: a three-center study

Simin Najafgholian

Background: Emergency Departments (EDs) visits reflect medical needs and demands or the only care available to patients. Many ED visits are potentially preventable with access to high-quality, community-based health care. Given the higher incidence of emergency conditions in patients with cancer the global increase in cancer will pose a challenge for emergency services. Therefore, this study was conducted with the aim of epidemiological investigation of emergency department visits by cancer patients in several centers.
Methods: In this cross-sectional study, the triage form and hospital file of known patients with various cancers, who visited in Eds of valiasr and Amir al Momenin hospitals in Arak, Hazrat Rasool Akram and Lolagar hospitals in Tehran, and Shahid Sadouqi and Shah vali hospitals in Yazd, From April to September 2017. To measure the urgency of ED visits, the emergency severity index and triage form were used, and the outcome of the emergency visit was extracted from the patient's file and recorded in the data collection checklist. Multivariate logistic regression analysis was used to examine the association of patient, hospital and potentially preventable factors.
Results: In this study, 1107 patients, 550 men (%49.7) and 577 women (%50.3) with cancer were were studied. Age 65 and older had the most emergency visits. The most common reason for patients to visit was: pain in different organs (18.2%), fever (8.7%), weakness and malaise (7.5%). A total of 617 (55.7%) visits were potentially preventable. Age 17 years and younger (OR, 3.172; 95% (CI), 2.409-4.021) and presence of more than 1 comorbidity (OR, 3.610; 95% (CI), 3.611-4.521) were positively associated with potentially preventable visits.
Conclusion: In this study, 50.7% of ED visits among patients with cancer were identified as potentially preventable, and the most common reason for patient visits was general and non-specific symptoms such as pain, weakness, and malaise. These findings highlight the need for palliative care and evidence-based interventions in outpatient settings.

Determining the diagnostic reference levels (DRL) of CT scan imaging in Saveh Hospitals: a brief report

Mehran Mohseni

Background: Based on the recommendation of the European Committee and ICRP, DRL values should be determined at the local, national and regional levels for CTDI_vol (Computed Tomography Dose Index _volume) and DLP (Dose Length Product) dose indicators. According to the radiation protection guidelines, it is essential study has determined DRL in Saveh hospitals
Methods: This study was conducted with two methods based on the results and calculations obtained from the annual Quality Control (QC) reports and the Data Collection (DC) method related to patient scans. In this study, by referring to the annual reports of each device and using radiation components during dosimetry and determining CTDI_air or CTDI_w, the correction factor was obtained. Using this factor and existing equations, DLP and CTDI_vol were calculated based on quality control standards. The second quartile or the median was determined as DRL for head, sinus, chest and abdomen/pelvis imaging protocols and its values were compared with each other and other studies. This study was conducted in February and March 2023 in three hospitals in Saveh city.
Results: The diagnostic reference levels of CTDI_vol index were obtained in both QC and DC methods for head (32.76 and 32.36), sinus (11.73 and 9.89), chest (6.06 and 5.11) and abdomen/pelvis (11.86 and 10.56) imaging. The highest DRL values of DLP index in both QC and DC methods are for head, abdomen/pelvis, chest and sinus CT scans, respectively. In the QC method, these values were (603.99), (478.15), (187.15), and (132.65) respectively, and in the DC method, the values were (601.84), (427.76), (219.01), and (114.81) mG.cm.
Conclusion: According to the results of this study and the lack of significant difference between the DRL values of CTDI_vol and DLP indicators in both QC and DC methods, it is recommended that the centers, if they have the acceptance criteria for annual quality control, can determine the DRL by referring to the device console information from the DC method.

Small bowel obstruction due to cecal leiomyoma: a rare presentation and case report

Rasul Nikdel

Background: Benign tumors of the gastrointestinal tract with a muscular origin are typically found in the esophagus, stomach, or small intestine, and rarely in the large intestine. Approximately 3% of all gastrointestinal leiomyomas occur in the large intestine, primarily in the descending colon and sigmoid colon. These lesions are usually asymptomatic and are often discovered during endoscopic procedures.
Case Presentation: A 38-year-old female patient admitted to the emergency department of Imam Ali Hospital in Bojnurd city in January 2024, reporting vague and nonspecific lower abdominal pain, abdominal distension, nausea, vomiting, low appetite and signs of partial gastrointestinal obstruction over the past week that don’t have any history of weight loss, gastrointestinal bleeding, constipation or family history of cancer. Her symptoms had not responded to Over-the-counter (OTC) medicines and outpatient treatment. Given the nonspecific manifestations, a CT scan of the abdomen and pelvis with iv contrast was requested for further evaluation of inta abdominal disease. The CT findings indicated a 5.5 cm lesion at the beginning of the large intestine, which exerted pressure on the distal part of small intestine, leading to evidence of partial obstruction of the distal part of small intestin. The patient was diagnosed with small bowel obstruction due to an ascending colon tumor and was scheduled for surgical intervention. She underwent resection of right colon, 10-15 cm of terminal ileum along with drainage of the regional lymph nodes. The excised tissue sample was sent for histopathological examination, which suggested a benign colon tumor likely to be a leiomyoma. To facilitate a more accurate diagnosis, immunohistochemical analysis was recommended, which confirmed the diagnosis of leiomyoma.
Conclusion: Colonic leiomyomas can present with various symptoms depending on their size and location. Due to the difficulty in differentiating leiomyomas from malignant colonic tumors, particularly when they are larger, surgical intervention is often recommended. This case highlights the importance of early diagnosis and appropriate management strategies for these tumors to prevent potential complications.