Journal of Research in Medical Sciences1735-19953058202508041168411684EN20250804<p><strong>Background:</strong> Although there are a few options for the treatment of patients with econdary progressive multiple sclerosis (SPMS), rituximab (RTX) is used as an off?label treatment. This study aimed to investigate the efficacy of RTX on disability status and volumetric magnetic resonance imaging (MRI) findings in SPMS.</p><p><strong> Materials and Methods:</strong> This study was conducted on 31 patients with SPMS treated with RTX 1000 mg travenously every 6 months. Expanded Disability Status Scale (EDSS), 25?Foot Walk Test (25?FWT), 9?Hole Peg Test (9?HPT), and brain MRI were performed at the baseline and after 12 months.</p><p><strong>Results:</strong> No significant changes were observed in EDSS, timed 25?FWT, and 9?HPT within 12 months of RTX treatment (P &gt; 0.05). There was a decrease in 9?HPT time in both the right and left hands, but it was not significant. During the 12?month assessment, white matter (WM) and gray matter volumes decreased by ?41.48 ± 2.36 and ?31.65 ± 8.84, respectively. However, these differences were not statistically  ignificant (P &gt; 0.05). The only significant change was an increase in the volume of deep WM lesions (WMLs) (0.26 ± 0.19 vs. 0.38 ± 0.29, P = 0.024). A significant association was found between the EDSS at the 12th month and baseline deep WML volume (r = 0.383, P = 0.044).</p><p><strong> Conclusion:</strong> Our results showed that the level of disability based on EDSS, timed 25?FWT, and 9?HPT did not increase significantly during 12 months of treatment with RTX. These findings suggest that RTX may play a role in disease stabilization and preventing disability progression, especially in the upper limbs. Further studies with larger sample sizes are necessary to confirm this finding.<br /><br /></p>http://jrms.mui.ac.ir/index.php/jrms/article/view/11684http://jrms.mui.ac.ir/index.php/jrms/article/download/11684/6457

Journal of Research in Medical Sciences1735-19953058202508041168611686EN20250804<p><strong>Background:</strong> High?normal blood pressure (BP), situated inside the elevated normal range and indicative of potential hypertension, is widely acknowledged as a critical worldwide health issue. High?normal BP levels consist of a systolic measurement of 130–139 mmHg<br />and a diastolic measurement of 85–89 mmHg. Ischemia?modified albumin (IMA) is a sign that tissues are not getting enough oxygen, which is also known as tissue hypoxia. Numerous studies indicate that IMA possesses prognostic relevance in cardiovascular diseases. Our purpose was to investigate the serum IMA levels in patients with igh?normal BP.</p><p><strong>Materials and Methods:</strong> The study prospectively enrolled 50 participants with  igh?normal BP and 50 individuals with normal BP consecutively. Both groups’ IMA levels were assessed and compared. All patients’ echocardiograms were collected.</p><p><strong>Results:</strong> The IMA values were markedly elevated in the high?normal group (P &lt; 0.001). The research identified a significant correlation between IMA and high?normal BP, with an odds ratio of 1.725 (95% confidence interval [CI] 1.212–2.506, P &lt; 0.001). An IMA level of 348 ng/L demonstrated a 94% accuracy in predicting high?normal BP, with a 32% ccuracy overall (area under the curve = 0.942; 95% CI, 0.894–0.991; P &lt; 0.001).</p><p><strong>Conclusion:</strong> Our analysis demonstrated a strong correlation between IMA and high?normal BP. </p>http://jrms.mui.ac.ir/index.php/jrms/article/view/11686http://jrms.mui.ac.ir/index.php/jrms/article/download/11686/6459

Journal of Research in Medical Sciences1735-19953058202508041168811688EN20250804<p><strong>Background:</strong> Cardiac involvement in sarcoidosis is associated with high mortality but is often underrecognized due to diagnostic challenges. Advanced imaging modalities like Cardiac Magnetic Resonance (CMR) and Fluorodeoxyglucose Positron Emission omography (FDG-PET) are highly sensitive for detecting myocardial inflammation and scarring, aiding in the diagnosis and management of cardiac sarcoidosis. The objective of this study was to characterize the imaging features of cardiac sarcoidosis in Iranian patients using these advanced cardiac imaging modalities.</p><p><strong> Materials and Methods:</strong> This multicenter prospective study included 42 Iranian patients with biopsy-proven extracardiac sarcoidosis who met the Japanese Circulation Society criteria for cardiac involvement. All patients underwent CMR to evaluate myocardial function, edema, scarring, and strain. 28 patients also underwent FDG-PET/CT to assess active myocardial inflammation.</p><p><strong>Results:</strong> In our study of 42 cardiac sarcoidosis patients (50% male, mean age  7.14±14.33 years), CMR revealed reduced left ventricular ejection fraction  34.2±13.7%) in 83.3% of patients, with late gadolinium enhancement (LGE) present in 88.1%. LGE was most frequent in the basal anteroseptal and mid inferoseptal/anteroseptal segments, with midwall (35.5%) and subepicardial (23.7%) patterns predominating. Global strain analysis showed impaired values: longitudinal -10.08±4.14%, radial 15.38±8.55%, and ircumferential 0.79±4.63%. Mean T1 and T2 values were 1054.60±50.98 ms and 52.59±4.53 ms, respectively. FDG-PET demonstrated active disease in 67.9% of cases, predominantly involving the apical septum, basal inferolateral, and mid inferolateral segments. The left anterior descending artery territory showed the highest involvement in both active inflammation (44.3% of affected segments) and scarring (39.2% of affected segments).</p><p><strong> Conclusion:</strong> CMR and FDG-PET provided comprehensive assessment of cardiac  volvement in this Iranian cardiac sarcoidosis cohort, with predominant basal and lateral wall involvement. Regional differences highlight the importance of population-specific studies.<br /><br /></p>http://jrms.mui.ac.ir/index.php/jrms/article/view/11688http://jrms.mui.ac.ir/index.php/jrms/article/download/11688/6461

Journal of Research in Medical Sciences1735-19953058202508041168511685EN20250804Although bariatric surgery is recommended for obesity treatment, there is an increasing trend toward comorbidity?related indications. The effects of bariatric surgery on mortality are inconsistent. This meta?analysis aimed to assess metabolic surgery versus usual<br />care on mortality among patients with obesity and type 2 diabetes. we searched six databases for articles comparing bariatric surgery with usual care in terms of mortality. The terms used were bariatric surgery, metabolic surgery, lifestyles, usual care, gastric<br />banding, bypass surgery, biliopancreatic diversion, gastric bypass, sleeve gastrectomy, and Roux?en?Y gastric bypass. The search engine was set for articles from inception up to June 2024. Out of the 1960 studies retrieved, 1810 were retained after the removal of<br />duplication; from them, 75 full texts were eligible, and only 26 studies were included in the final meta?analysis. The study included 866,159 patients (167,152 patients who  underwent bariatric surgery and 699,007 usual care patients) and 91,211 deaths. ortality was lower among patients with bariatric surgery compared to usual care (3.1% vs. 2.6%), odds ratio = 0.43, 95% confidence interval (CI), 0.32–0.58, Chi?square = 1638.20, and P &lt; 0.001, I2 for heterogeneity = 99%, and the standard difference = 24. Mortality was higher in bariatric surgery in subgroup meta?analysis on patients with type 2 diabetes (2.6% versus 2.0%), odds ratio, 0.63, 95% CI, 0.42–0.95, Chi?square = 101.04, and P = 0.03 I2 for heterogeneity = 95%, and the standard difference = 5. Bariatric surgery was associated with lower mortality in patients with obesity compared to usual care, but higher mortality in subgroup meta?analysis in type 2 diabetes. Larger, well?controlled trials are needed.<br /><br />http://jrms.mui.ac.ir/index.php/jrms/article/view/11685http://jrms.mui.ac.ir/index.php/jrms/article/download/11685/6458

Journal of Research in Medical Sciences1735-19953058202508041168711687EN20250804---http://jrms.mui.ac.ir/index.php/jrms/article/view/11687http://jrms.mui.ac.ir/index.php/jrms/article/download/11687/6460