Medical Science and Discovery <p><span style="font-family: Arial; font-size: small;"><strong>Medical Science and Discovery</strong> (ISSN: 2148-6832) is an international open access, peer-reviewed scientific research journal that provides rapid evaluation of articles in all disciplines of Medical Sciences.&nbsp;</span></p> en-US <p><a href="" target="_blank" rel="noopener"></a></p> (Asghar Rajabzadeh) (Elena Jalba) Fri, 30 Jul 2021 19:53:38 +0300 OJS 60 Impact of iron status and inflammatory indices on atherosclerotic burden of patients with helicobacter pylori infection and coronary arterial disease <p><strong>Objective:</strong> Both inflammation and iron deficiency are suggested to be associated with coronary arterial diseases (CAD) and <em>H. Pylori</em> infection. The explanatory interaction depending on serum iron status and inflammatory biomarkers for the extent of atherosclerosis in H. Pylori infection is obscure. Therefore, we aimed to analyze the impact of iron Status and inflammatory indices on atherosclerotic burden of seropositive CAD patients with CagA (cytotoxin-associated gene A) strains of <em>H. Pylori</em>.</p> <p><strong>Materials and Methods:</strong> This was an observational study of patients' undergone elective and urgent coronary angiography due to CAD. Serologic <em>H. pylori</em> infection status and iron status was determined in all of 293 subjects. Further seropositive patients were divided into groups to evaluate the extent of coronary atherosclerosis according to Syntax scoring system. Propensity score matching and covariate- adjusted multivariate logistic regression were used to adjust for baseline differences between study groups.</p> <p><strong>Results:</strong> The odds ratio of positive serology for the presence of iron deficiency and acute coronary syndromes were 2.5 (95% CI (1.1-5.4); p = 0.02) and 3.0 (95% CI (1.3-7.0); p = 0.007) respectively. After controlling for diabetes mellitus, smoking, MPV, RDW and haemoglobin levels; Tsat ≤ 24.5 remained negatively associated with advanced atherosclerosis (OR:9.9, 95% CI (4.1-24.3); p &lt; 0.0001). In our matched sample, multivariable linear regression analysis showed that association of syntax score with Tsat was independent of hs-CRP&nbsp; (p=0.001).</p> <p><strong>Conclusions:</strong> Irrespective of inflammatory status, transferrin saturation can be the decisive mirror indicator of advanced atherosclerosis in seropositive CAD patients with CagA strains of H. Pylori.</p> Baris Sensoy, Nur Ozer Sensoy Copyright (c) 2021 Baris Sensoy, Nur Ozer Sensoy Thu, 01 Jul 2021 00:00:00 +0300 The Relationship between working memory and expressed emotion in the related caregivers of psychotic patients <p><strong>Objective:</strong> To investigate the relationship between Expressed Emotion (EE) and working memory (WM) capacity in the caregivers of patients with psychosis, controlling for the potential confounds, namely, personality traits, subsyndromal psychotic symptoms, burden of care and the patient’s illness severity.</p> <p><strong>Materials and Methods:</strong> The study covered 152 related caregivers of psychotic patients diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder with a psychotic component. The study continued with 120 participants who met the recruitment criteria. Patients were assessed with a Structured Clinical Interview for Axis I Disorders (SCID-I), the Brief Psychiatric Rating Scale (BPRS), and the Clinical Global Impression Scale (CGI). For related caregivers; SCID-I, Expressed Emotion Scale (EES), Temperament and Character Inventory (TCI); Magical Ideation Scale; Physical Anhedonia Scale; Social Anhedonia Scale; Zarit Caregiver Burden Scale (ZCBS), and Auditory Consonant Trigram Test (ACT) were used. A stepwise regression analysis was employed to analyze the relevant variables that had an independent impact on EES scores.</p> <p><strong>Results:</strong> There was a significant negative relationship between the ACT and EES scores (r=-.25, p&lt;0.01). The ZCBS score (beta: 0.355, p&lt;0.01), Harm Avoidance subscale of the TCI (beta: 0.231, p&lt;0.01), and CGI overall improvement subscale (beta: 0.237, p&lt;0.01) were independently associated with the EES score.</p> <p><strong>Conclusions:</strong> There have been few studies investigating the biological basis of this clinical characteristic. The present study found no significant relationship between WM and EE in terms of the effect of WM in the caregivers of patients with psychosis.</p> Pınar Eraslan, Eylem Şahin Cankurtaran, Semra Ulusoy Kaymak, A. Haldun Soygür, E. Cem Atbaşoğlu Copyright (c) 2021 Pınar Eraslan, Eylem Şahin Cankurtaran, Semra Ulusoy Kaymak, A. Haldun Soygür, E. Cem Atbaşoğlu Mon, 26 Jul 2021 00:00:00 +0300 Artificial intelligence in the endocrine clinic: automated bone age analysis in arabic children from UAE <p><strong>Objective:</strong> Artificial intelligence (AI) is playing an increasing role in patient assessment. AI bone age analysis is such a tool, but its value in Arabic children presenting to an endocrine clinic has not been explored. We compared results from an experienced pediatric radiologist and the AI bone age system, BoneXpert (BX), (Visiana, Denmark) to assess its utility in a cohort of children presenting to the Al Jalila Children’s Specialty Hospital endocrine service.</p> <p><strong>Materials and Methods:</strong> We conducted a retrospective chart review of 47 children with growth disorders, initially assessed by a single experienced radiologist and subsequently by BX, to confirm the usefulness of the BX system in our population. The results of the analyses were analysed using a Bland-Altman plot constructed to compare differences between the radiologist’s interpretation and BX across the available range of bone age.</p> <p><strong>Results:</strong> Forty-four of the patient x-ray images were analysed by BX. Three X-ray images were rejected by BX due to post-processing artifacts, which prevented computer interpretation. For the remaining 44 X-rays, there was a close correlation between radiologist and BX results (r=0.93; p &lt;0.00001).&nbsp; Two radiographs were identified with a large discrepancy in the reported bone ages. Blinded, independent re-evaluation of the radiographs showed the original manually interpreted bone age to have been erroneous, with the BX results corresponding closely to the amended bone age. A small positive bias was noted in bone age (+0.39 years) in the BX analyses, relative to manual interpretation.</p> <p><strong>Conclusions:</strong> AI bone age analysis was of high utility in Arabic children from UAE presenting to an endocrine clinic, with results highly comparable to an experienced radiologist. In the two cases where a large discrepancy was found, independent re-evaluation showed AI analysis was correct.</p> Nandu Kumar Thalange; Elham Elgabaly Moustafa Ahmed; Ajay Prasanth D'Souza, Mireille El Bejjani Copyright (c) 2021 Nandu Kumar Thalange; Elham Elgabaly Moustafa Ahmed; Ajay Prasanth D'Souza, Mireille El Bejjani Wed, 28 Jul 2021 00:00:00 +0300 Can tissue nitric oxide synthesis 2 (iNOS) levels play a role in the pathophysiology of reflux esophagitis? <p><strong>Objective:</strong> Nitric oxide (NO) is a strong dilatator, playing an important role in inflammatory events. Its production is regulated by NO synthase 2 (NOS2/iNOS). Our aim was to compare iNOS in esophageal tissues of patients with erosive or non-erosive reflux esophagitis to that of normal cases.</p> <p><strong>Materials and Methods:</strong> The study was conducted in 2019–2020 on patients undergoing upper gastrointestinal (UGI) endoscopy. Study included 30 patients who had no reflux symptoms and were not diagnosed with reflux esophagitis in the UGI endoscopy (control), 22 who had pronounced reflux symptoms but could not be diagnosed with reflux esophagitis in the endoscopy (non-erosive reflux), and 51 who had reflux esophagitis in the endoscopy (erosive reflux esophagitis). Using the enzyme-linked immunosorbent assay, tissue iNOS levels were assessed on samples from the lower end of the esophagus.</p> <p><strong>Results:</strong> Average iNOS level was 5.02±1.51 picogram/milliliter (pg/mL) in the normal group and 5.04±1.68 pg/mL in all reflux esophagitis cases. iNOS levels were higher in non-erosive reflux and lower in erosive reflux than in controls. In erosive reflux A, B, and C, iNOS levels were 5.03±1.64, 5.10±2.23, and 4.06±0.02 pg/mL, respectively. The level in erosive reflux C is considerably lower than in the normal group. However, none of the differences between the groups was significant.</p> <p><strong>Conclusions:</strong> NO synthase was higher in patients with non-erosive reflux esophagitis and considerably lower in those with erosive reflux C, compared to the normal cases. Although not significant, the differences suggest that NO and iNOS levels may be important in reflux physiopathology.</p> Enver Akbaş, Gözde Ülfer Copyright (c) 2021 Enver Akbaş, Gözde Ülfer Mon, 26 Jul 2021 00:00:00 +0300 Effectiveness and safety of orally administered silymarin (milk thistle) for pegylated interferon unresponsive chronic delta hepatitis patients <p><strong>Objective:</strong> Silymarin is a natural extract from milk thistle (Silybum marianum), a natural herb that contains flavonoids. Silymarin also has anti-inflammatory properties and lipid peroxidation effects on human hepatocytes. It has also been used for the treatment of acute alpha-amanitin poisoning and chronic hepatitis C infection.&nbsp; Chronic Hepatitis D virus (HDV) infection is a severe health problem leading to fibrosis and hepatocellular carcinoma. Patients with chronic HDV infection can be treated with Peg-IFN with lower treatment success.&nbsp; Most patients with chronic HDV are unable or unwilling to use interferon (IFN)-based treatment due to liver cirrhosis. Our objective was to establish the long-term clinical outcomes with silymarin for interferon-experienced chronic HDV patients.</p> <p><strong>Materials and Methods:</strong> We studied ten patients from one centre with interferon who experienced chronic HDV, of which 8 had cirrhosis, and 2 had chronic hepatitis who received HDV treatment with silymarin 600 mg/day after a median period of 12 months. Information collected included demographic, clinical, virologic, and outcomes data. MELD and Child-Pugh (CP) scores were also obtained. Friedman test was used to evaluate the laboratory parameters during the study period.</p> <p><strong>Results:</strong> 10 chronic HDV patients (median age 54 yrs, six female, all of them previous null responders to Peg-IFN&nbsp; with mildly decompensated cirrhosis [CP 7 (range 6-11), MELD 11 (range 6-20] were followed for 12 months from the start of silymarin 600 mg/day. There was no decompensation of both MELD and CP scores among patients at the end of therapy. In addition, no patients stopped silymarin treatment early due to side effects. At the end of treatment, there was no significant change in prothrombin time (p= 0.949), AST (p=0.662) and AFP (p=0.983) levels and platelets counts (p=0.988) compared to the pre-treatment period (all p&gt;0.005). Finally, HDV-RNA suppression was seen in all patients at the end of treatment (p=0.009).</p> <p><strong>Conclusions:</strong> In the light of the presented data, silymarin seems to be effective in treating chronic HDV infection. Further research is needed for validation. The study is ongoing with a collection of data on sustained viral response.</p> Mesut Aydin, Erhan Ergin, Elif Tugba Tuncel, Yaren Dirik, Suat Ozluk, Huseyin Guducuoglu, Ahmet Cumhur Dulger Copyright (c) 2021 Mesut Aydin, Erhan Ergin, Elif Tugba Tuncel, Yaren Dirik, Suat Ozluk, Huseyin Guducuoglu, Ahmet Cumhur Dulger Thu, 22 Jul 2021 00:00:00 +0300 Determination of risk factors using Nonlinear Principal Component Analysis in patients with breast tumour <p><strong>Objective:</strong> Breast cancer, which is the most common among women in the world and constitutes approximately 30% of all cancers, takes places near the top among the diseases that threaten women's health. The purpose of this study is to determine the risk factors in patients with breast tumours using nonlinear principal component analysis.</p> <p><strong>Materials and Methods:</strong> During the application process, a data set of 569 (357 benign, 212 malign) patients with breast tumours was used. To find independent features, the data set was reduced to two dimensions via nonlinear principal component analysis. The results were evaluated by comparing the success of the method with the ROC curve.</p> <p><strong>Results:</strong> The cut-off values for the radius, perimeter, area, smoothness and texture of the tumour were 14.19, 656.10, 0.09, 2.87 and 0.11, respectively. The sensitivity of the current values according to the results of ROC analysis was determined as 84% for radius, 80% for perimeter, 86% for the area and 94% for texture. It is seen that the method has an overall success of over 80% in detecting malignant tumours.</p> <p><strong>Conclusions:</strong> It is hoped that this method, which is used to reveal risk factors and identify distinctive features in breast tumours, will reduce medical costs and provide a second opinion to physicians. In terms of decision making, it is predicted that the method can recognize malignant tumours and reduce the need for unnecessary biopsy for benign tumours.</p> Canan Demir Copyright (c) 2021 Canan Demir Wed, 28 Jul 2021 00:00:00 +0300 Cognitive rehabilitation effectiveness for severe to moderate traumatic brain injury: case series <p><strong>Objective:</strong> This case series study aimed to investigate the effectiveness of a holistic approach of a computer-assisted and traditional neuropsychological rehabilitation program in improving some cognitive functions in patients who sustained a traumatic brain injury (TBI).</p> <p><strong>Methods:</strong> The case series study followed a single-case design, with an A-B-A-B design and was conducted in the rehabilitation center at King Fahad Medical City-Saudi Arabia between Aug 2015 and March 2016. Participants comprised 5 males with moderate-to-severe TBI and persistent cognitive impairments. The computerized model included known software programs for cognitive rehabilitation to improve this rehabilitation process. The program period was six weeks for each case, all focusing on executive functions, memory, and attention.</p> <p><strong>Results:</strong> three out of the five cases improved remarkably in their attentional, executive, and related memory functions; with one showing moderate improvement and the five-case showing little improvement.</p> <p><strong>Conclusion:</strong> The holistic approach of the neuropsychological rehabilitation program is effective for some TBI cases in improving their cognitive and psychosocial functioning, alongside vocational outcomes, as reported in the follow-up interviews of the patients and their families. More research is required to contribute to the current literature and for the study's findings to be further analyzed for these interventions.</p> Ahlam Ibrahim Hamami Copyright (c) 2021 Ahlam Hamami Sat, 17 Jul 2021 00:00:00 +0300