The results of previous studies on the association between IL-6-174G/C (rs1800795) polymorphism and inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC) are not consistent. The present meta-analysis has pooled all eligible studies to understand the relation between this gene polymorphism and IBD risk. A structured search of Medline, EMBASE, and Scopus databases were performed to identify all eligible studies published before June 2017. Odds ratio (OR) and 95% confidence intervals (CIs) were assessed applying fixed- or random-effect models to evaluate the strength of association in recessive model, dominant model, allelic model, heterozygote contrast, and homozygotes contrast. A sum of 9 articles with 1524 IBD cases and 1586 healthy subjects were included in this study. No significant association between the IL-6 -174 G/C polymorphism and overall IBD susceptibility in any tested genetic model was found. Moreover, in the subgroup analysis based on subtypes, the associations between the IL-6 174-G/C polymorphism and CD and UC missed statistical significance. The current meta-analysis suggests that the IL-6-174 G/C polymorphism is not associated with IBD susceptibility. Further and comprehensive studies are necessary to warrant this result.

 End-stage kidney disease has a high prevalence in patients undergone Coronary Artery Bypass Grafting (CABG) and could cause a wide spectrum of morbidities, due to deep water and electrolyte or acid-base impairments. The aim of this study was to assess the effect of low Creatinine Clearances (ClCr) on arterial oxygenation defect, as common post-CABG morbidity. The study was conducted as a prospective cohort, the pure on pump CABG patients were grouped based on their preoperative ClCr to groups A (ClCr≥60) and B (ClCr<60). Postoperatively, the PaO2/FiO2 values in 1 hour after ICU admission and 4 hours after extubation, intubation time duration, duration of ICU stay and high concentration oxygen demand were compared. Among 229 patients who remain in the study, 121 were in group A, and 108 in B group. Except for age, weight, height, BMI, and pump time, other demographic and independent variables were similar between two groups. The higher values of PaO2/FiO2 and PaO2, 1 hour after ICU admission and 4 hours after extubation in group B, were not statistically significant, while SpO2 value, 1 hour after ICU admission was higher in group B (98.19±1.37) in compare with group A (97.78±1.57) (P=0.040). Intubation time duration (10.85 in A vs. 12.79 in B; P=0.306), duration of ICU stay (39.04 in A vs. 43.09 in B; P=0.114) and high concentration oxygen demand (2.5% in A vs. 3.8% in B; P=0.089) were similar between groups of study. Lower Preoperative ClCr values do not deteriorate post-CABG arterial oxygenation.

Clozapine is an atypical antipsychotic employed to treat patients with psychotic disorders. It is associated with sialorrhea as a problematic adverse effect in 30-80% of cases. Various medications such as atropine and amitriptyline have been suggested for its treatment. We aimed to compare the effects of atropine drops and amitriptyline tablets in the treatment of clozapine-induced sialorrhea. The present double-blind, randomized clinical trial aimed to evaluate the effect of atropine drops and amitriptyline tablets in reducing clozapine-induced sialorrhea in patients with psychotic disorders. Forty-six patients were treated for 4 weeks in two groups: group “A”(atropine drops and placebo tablets) and group “B” (amitriptyline tablets and placebo drops). Toronto Nocturnal Hypersalivation Scale (TNHS) and Clinical Global Impression (CGI) rating scale were used for measurement of the severity and frequency of sialorrhea and global symptom severity and treatment response, respectively. Kolmogorov–Smirnov, Chi-square and Fisher's exact tests were used for statistical analyses. Demographic information of the two groups had no significant difference (P>0.05). There was no patient with adverse effects that interfered with the study. Mean TNHS and Meier scores in groups “A” and “B” were 3.48±0.21 vs.3.24±0.18, and 1.9±0.07 vs.1.86±0.07, respectively, and the difference was not statistically significant (P=0.35 vs. P=0.67). In patients with clozapine-induced sialorrhea, 1% atropine drops (1.7 mg sublingual drops daily) can be just as effective as amitriptyline tablets (29.08 mg daily, oral) in controlling sialorrhea.

Polyneuropathy is one of the most common and disabling complications of diabetes. Severe pain is one of the complications of diabetic polyneuropathy .Over the years, many drugs for the treatment of the pain in diabetic neuropathy have been tried. However, no one is completely effective. In a single-blind clinical trial, 200 patients with painful diabetic neuropathy were studied over 12 weeks. In the intervention group, 100 patients were treated with 100 milligrams of Topiramate per day and 100 patients in the control group treated with 90 milligrams of Gabapentin per day. Pain intensity recorded with Visual analogue scale between 0 to 100 millimeter over twelve weeks. Reduction in pain intensity of ≥30 mm was considered as effective response. The purpose of this study was to investigate the effect of Topiramate in the treatment of pain in diabetic polyneuropathy. The mean reduction in pain intensity over twelve weeks in Topiramate groups were 33.83±12.17 and in Gabapentin group were 30.25±15.66. The relative improvement in the Topiramate group was 89.17%, and in the Gabapentin group was 71.25%, respectively. There was a reduction in the mean pain score in both groups, although no statistically significant difference between the two groups was observed. Both of Topiramate and gabapentin were effective on reduction of pain in diabetic polyneuropathy. We can use both of them separately or in combination with each other or other drugs.

Congenital anomalies or birth defects can be acquired during the fetal stages of development or from the genetic makeup of the parents. Congenital anomalies are important causes of infant and childhood illness and disability. Little is known about incidence and types of these anomalies in Iraqi Kurdistan. Therefore, this study was undertaken to estimate the incidence and types of congenital anomalies in Sulaimaniyah city. The study was carried out on the hospital's records of all newborns registered as having a congenital anomaly. The records of 586 neonates with congenital anomalies were analyzed from a total of 178,954 live broths that occurred during 4 years in the city. The data was obtained from the statistics section of maternal and a child unit of the Preventive Health Department. The overall incidence of all types of congenital anomalies over the four years was 3.3/1000 live births. There was a statistically significant difference in incidence between males and females over the four years, male to female risk ratio 1.2 (95% CI 1.02-1.42, P= 0.03). The commonest congenital anomalies affected the cardiovascular system accounting for 24% followed by those of the nervous system with 16%. Down syndrome accounted for 14% of all anomalies and cleft lip/palate for 11%. Types of anomalies were statistically associated with low birth weight and maternal age. The study indicates that the incidence of congenital anomalies is not high in the region; however, more extensive studies are required to give a more realistic incidence.  

The STROBE (strengthening the reporting of observational studies in epidemiology) statement presents recommendations to improve the reporting of observational studies. This study aimed to evaluate the quality of reporting the case-control articles indexed in the Scientific Information Database (SID). This descriptive study was conducted in 2016 in the all case-control articles indexed in the SID website over a 10-year period (2006 to 2015). The researchers visited the SID website and used the keywords of "case" and "control" in titles or keywords of the articles. Then, the STROBE checklist was completed for each article. Data were analyzed using descriptive statistics. The first item of the checklist was observed in 100% of the studied articles. None of these articles had described "duration of exposure" and "how missing data were addressed." None of these articles had used the flowchart. The quality of reporting in studied articles was acceptable, but some of the items in the STROBE checklist need more attention.

Acute appendicitis is considered as one of the most prevalent diseases needing urgent action. Diagnosis of appendicitis is often complicated, and more precision in diagnosis is essential. The aim of this paper was to construct a model to predict acute appendicitis based on pathology reports. The analysis included 181 patients with an early diagnosis of acute appendicitis who had admitted to Shahid Modarres hospital. Two well-known neural network models (Radial Basis Function Network (RBFNs) and Multi-Layer Perceptron (MLP)) and logistic regression model were developed based on 16 attributes related to acute appendicitis diagnosis respectively. Statistical indicators were applied to evaluate the value of the prediction in three models. The predicted sensitivity, specificity, positive predicted value, negative predictive values, and accuracy by using MLP for acute appendicitis were 80%, 97.5%, 92.3%, 93%, and 92.9%, respectively. Maine variables for correct diagnosis of acute appendicitis were leukocytosis, sex and tenderness, and right iliac fossa pain. According to the findings, the MLP model is more likely to predict acute appendicitis than RBFN and logistic regression. Accurate diagnosis of acute appendicitis is considered an essential factor for decreasing mortality rate. MLP based neural network algorithm revealed more sensitivity, specificity, and accuracy in timely diagnosis of acute appendicitis.

This study aimed to investigate the differences in pelvic incidence (PI) between three standing, maximal anterior and maximal posterior pelvic rotation. This cross-sectional study was done on 150 healthy subjects. Lateral spine radiography was taken in 3 different positions in the same standard radiographic protocol. Sacral slope (SS) pelvic tilt (PT), lumbar lordosis (LL) and lumbosacral junction angle were measured by two independent, experienced spine surgeons. PI was calculated as sum SS and PT. The mean of PI in standing positions was 52.6±5.1, in anterior position was 52.6±5.5 and in posterior position was 52.3±5.2 degree. The mean of PI, PT, and SS in total and between male and female subjects was not statistically significant in three different positions (P>0.05). PI in 136 subjects (90.7%) is changed when the position was changed from standing to the posterior position, by mean of 2.06 degree. When the position was changed from standing to an anterior position, the change in PI degree was observed in 126 subjects (84%) by mean of 2.12 degree. Despite the none, significant value of PI in three different positions, a large number of subjects with a change in their PI when the position was changed to anterior or posterior (90.1%) position, show that PI can be varied by pelvic rotation in healthy adult subjects.

Pheochromocytoma is a relatively rare tumor with no age preference. This tumor is usually diagnosed accidentally.  Pathologic fracture as the primary presentation of malignant pheochromocytoma is an uncommon presentation. The present case is a 23 year old man with malignant pheochromocytoma that his first chief complaint was bone pain due to pathological fracture. The presence of bone lesions as the first manifestation of pheochromocytoma makes this case a quite unusual one. 

Glomus tumor is not a rare vascular entity, which is often subungual or found in the reticular dermis of the extremities. Glomus tumors are most frequently benign and solitary. Affected patients classically complain of extremely painful episodes. Symptoms occur spontaneously or elicited by local compression and cold environment, in special if the tumor has an acral location. A 50-year-old woman was referred to our hospital due to chronic atypical episodes of wrist pain. A deep-seated subcutaneous nodule was detected in her right wrist, and a surgical biopsy was performed. Histopathology study revealed a benign glomus tumor with a solid pattern. Misdiagnoses involving glomus tumors with atypical symptoms or tumors developing in unusual sites are emphasized.

CD40 deficiency yield to an autosomal recessive subtype of hyper-immunoglobulin M syndrome (HGIM type 3), presenting with an almost identical clinical picture to X-linked CD40L deficiency (HIGM type 1) with profound T-cell dysfunction yielding to opportunistic infections as well as neutropenia, autoimmunity, and malignancy. We presented a girl with recurrent upper respiratory tract infections and lymphoid hyperplasia which was diagnosed with type 3 hyper IgM syndrome due to CD40 gene mutation. Otitis media with opportunistic germs and no evidence for an X-linked pattern of inheritance were diagnostic keys to type 3 hyper IgM syndrome in our patient.

Spontaneous coronary artery dissection (SCAD) is a rare but devastating cause of the acute coronary syndrome, malignant arrhythmias, and sudden cardiac death. It mainly affects young, middle-aged and otherwise healthy women. Oral contraceptive pills (OCP) and connective tissue disease are known as predisposing factors for SCAD. Here, we present a 43-year-old woman with a history of systemic lupus erythematosus (SLE), using OCP came with typical chest pain. With diagnosing inferior ST-elevation myocardial infarction, fibrinolytic therapy was done which aggravated her chest pain. Finally, the diagnosis of SCAD was proven by angiography and stenting was done. On the 6th day of her hospitalization, tachycardia occurred again, and trans-esophageal echocardiography was performed for the patient who showed partially flail anterior mitral leaflet. She was discharged from hospital after mitral valve replacement. This is a great dilemma in the management of a young woman with a history of connective tissue disease or vasculitis, like our patient who wants a contraceptive method.