Saeed Kargar-Soleimanabad

Background: Knee osteoarthritis (KOA) is a prevalent degenerative joint disease characterized by progressive structural and functional impairment. While magnetic resonance imaging (MRI) is regarded as the reference standard for assessing joint pathology, ultrasonography (US) offers a cost-effective, accessible, and dynamic alternative. This study aimed to evaluate the concordance between US and MRI findings in assessing key structural features of KOA. Methods: In this prospective cross-sectional study, 320 patients fulfilling the American College of Rheumatology (ACR) criteria for KOA underwent both standardized US and MRI of the affected knee. Imaging assessments included cartilage integrity, meniscal extrusion, marginal osteophytes, and joint effusion. MRI served as the reference imaging modality for calculating the diagnostic performance of US. Cohen’s kappa (κ), Spearman correlation, intraclass correlation coefficients (ICC), and Bland–Altman analyses were applied to evaluate agreement between modalities, while sensitivity, specificity, and diagnostic accuracy of US were calculated using MRI as the reference standard. Results: Good agreement was observed between US and MRI for osteophytes (κ = 0.79), joint effusion (κ = 0.67), and meniscal extrusion (κ = 0.52–0.72), whereas cartilage grading showed moderate agreement (κ = 0.52). US demonstrated high diagnostic performance for joint effusion (sensitivity = 98.7%, specificity = 100%) and strong correlations for quantitative meniscal extrusion (ρ = 0.79–0.96; ICC = 0.84–0.93, 95% CI: 0.600–0.957). Bland–Altman analysis demonstrated minimal measurement bias and narrow limits of agreement between the two imaging modalities. Conclusion: US provides a reliable, noninvasive, and accurate assessment of structural alterations in KOA, demonstrating strong agreement with MRI in evaluating joint effusion, osteophytes, and meniscal extrusion. These findings support the use of US as a valuable complementary imaging modality in the comprehensive evaluation of knee osteoarthritis, particularly when standardized imaging protocols are applied.

Context: This narrative review examines the association between emotional stress and autoimmune thyroid disease, particularly Graves’ disease and Hashimoto thyroiditis, and considers psychoneuroendocrine mechanisms relevant to thyroid autoimmunity. It also addresses the effects of stress on the immune system and on the hypothalamic–pituitary–thyroid (HPT) axis. Evidence Acquisition: Relevant English-language studies were identified through searches of PubMed, Google Scholar, and Web of Science and were synthesized narratively. Studies unrelated to stress or autoimmune thyroid disease were excluded. Results: Observational studies have linked psychological stress to autoimmune thyroid disease, particularly Graves’ disease; however, findings are heterogeneous, and causality has not been established. Proposed mechanisms include activation of the hypothalamic-pituitary-adrenal axis, the release of glucocorticoids and catecholamines, and subsequent immune modulation affecting the Th1/Th2 balance. Stressful life events have been associated with the onset and clinical course of Graves’ disease, whereas evidence for Hashimoto thyroiditis remains limited and inconsistent. Chronic stress may also contribute to dysregulation of the HPT axis and thyroid dysfunction. The review also considers lifestyle factors, including smoking, alcohol consumption, and educational level; other autoimmune diseases, including multiple sclerosis, rheumatoid arthritis, and psoriasis; and the effects of stress on pain, inflammation, and the endocrine system. Conclusions: Stress may contribute to disease onset, progression, and symptom burden in susceptible individuals. Stress management and lifestyle modification may serve as useful supportive measures; however, further research is needed to clarify their roles in the pathogenesis, exacerbation, and treatment of autoimmune thyroid disease.

Introduction: Avulsion fractures of the posterior cruciate ligament (PCL) are rare occurrences following knee trauma and are frequently missed during the initial assessment. These injuries are often overlooked due to subtle radiographic signs and the difficulty of performing a thorough physical examination in the presence of acute pain. Prompt and accurate diagnosis is essential to prevent long-term functional impairment of the knee. Case presentation: We report the case of a 42-year-old woman who sustained trauma to her left lower limb after falling from a height of approximately 3 m. She underwent orthopedic surgery for fractures in the left foot and was discharged in stable condition. However, during the second follow-up visit, persistent discomfort around the knee prompted further imaging. Radiographs revealed a previously undiagnosed avulsion fracture of the PCL in the left knee, which had not been identified during the initial trauma evaluation. Clinical discussion: This case highlights the diagnostic challenges associated with PCL avulsion fractures, particularly when overshadowed by more apparent injuries. It underscores the importance of maintaining a high index of suspicion and conducting comprehensive evaluations, including repeat imaging when clinical symptoms persist. Conclusion: Clinicians should be aware of the potential for missed PCL avulsion fractures, especially in polytrauma patients. Early recognition and management are critical to ensuring optimal functional recovery.

Background: Deep vein thrombosis (DVT) remains a frequent and potentially life-threatening complication among hospitalized patients, necessitating timely diagnosis. The Wells score is widely used for assessing DVT probability; however, its performance in inpatient populations remains uncertain. This study aimed to evaluate the diagnostic accuracy of the Wells criteria for lower extremity DVT among hospitalized patients. Methods: In this case–control study conducted at two teaching hospitals between 2017 and 2020, 240 patients with confirmed DVT were compared with 240 age- and sex-matched controls without DVT. All participants underwent standardized clinical evaluation and duplex ultrasonography within 24 h of admission. Wells scores were calculated based on predefined clinical parameters. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. Results: Of 480 participants (mean age 51.9 ± 11.6 years; 54.4% female), DVT was confirmed in 240 (50%). A Wells score ≥2 classified patients as likely DVT. This threshold yielded a sensitivity of 86.3%, specificity of 70.0%, PPV of 74.2%, and NPV of 83.8%. Significant predictors included recent surgery or prolonged hospitalization ( p < 0.001), calf swelling >3 cm ( p < 0.001), and pitting edema confined to the symptomatic leg ( p < 0.001). Conclusion: The Wells criteria demonstrated good sensitivity and moderate specificity for diagnosing DVT in hospitalized patients, supporting their role as an initial clinical assessment tool. However, they should not replace confirmatory testing such as ultrasonography or D-dimer assays. Larger multicenter studies are warranted to further validate these findings.

Background: Although direct laryngoscopy may seem the most reasonable modality for previously intubated patients, in the setting of anatomical distortion secondary to reconstructive neck surgery, flexible fiberpostoptic laryngoscopy (FFL) should be considered for patients who may require postoperative emergency reintubation. Case Presentation: A 51‐year‐old woman with squamous cell carcinoma of the submental triangle and larynx was referred for free flap surgery. For postoperative care, she was admitted to the ICU. After 18 h, the patient developed respiratory distress and confusion. We decided to perform awake tracheal intubation for her. After receiving a sufficient dose of fentanyl and dexmedetomidine, intubation with direct laryngoscopy was attempted, but it failed. Fortunately, the patient was intubated using an FFL available in the ICU. After 48 h, she was extubated and transferred to the surgery ward. Conclusion: Our experience suggests that, for patients who are undergoing free flap surgery in regions that jeopardize the airway, if intubation is needed (especially shortly after surgery), difficult airway management devices such as FFL should be readily accessible alongside an expert anesthesiologist.

Background: The present study aims to compare the efficacy of intravenous pethidine with sublingual buprenorphine in pain relief following surgical intervention for vertebral fractures. Method: This study is a randomized, double-blind clinical trial conducted among individuals undergoing surgery for thoracic and lumbar vertebral fractures. Before surgery, all patients received 1 g of intravenous acetaminophen. Sublingual buprenorphine was administered at 0.4 mg in three doses before surgery and two doses after surgery. Alternatively, patients received intravenous pethidine at a dose of 25 mg in two doses before surgery and one dose after surgery. Postoperative pain was monitored for the first 24 h using the Visual Analog Scale, and any treatment-related adverse effects were also assessed. Results: In this study, the mean age of patients was 55.10 ± 13.24 years, with 55% being male. Only 16 (13.3%) of the patients evaluated experienced nausea and vomiting. The most common fracture site among the subjects was lumbar, with a frequency of 72 patients (60%). The mean pain scores increased postoperatively compared to preoperative scores and decreased over time. No statistically significant differences were observed between the two groups at any time point. According to the repeated measures analysis of variance statistical test, two groups had no significant changes in pain levels. Discussion: Sublingual buprenorphine does not differ from intravenous pethidine regarding pain intensity following vertebral fracture surgery; however, it is considered safer with fewer side effects. Furthermore, the trend of pain changes in both treatment groups did not show significant differences.

Individuals with non-small cell lung cancer (NSCLC) who develop brain metastases face a poor prognosis and limited treatment options. Programmed cell death protein 1 (PD-1) inhibitors, such as pembrolizumab and nivolumab, have emerged as a promising immunotherapy for treating lung cancer with brain metastases. This systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline and evaluate the safety and efficacy of anti-PD-1/PD-L1 monoclonal antibodies in treating lung cancer patients with brain metastases. A comprehensive literature search was conducted to identify relevant studies up to 27 August 2023. Data on overall survival (OS), progression-free survival, radiological response rates, and adverse events were extracted. All statistical analysis was performed using STATA v.17. Our literature search yielded 39 eligible studies involving 15,428 patients. The overall response rate for PD-1 inhibitors was substantial, with pooled rates of 39% for overall response, 7% for complete response (CR), 27% for partial response (PR), and 31% for stable disease (SD). The pooled 6-month OS rate was 77%, and the 1-year OS rate was 61%. Subgroup analyses revealed higher PD-L1 expression levels and the use of platinum-based chemotherapy alongside immunotherapy were associated with improved outcomes. PD-1/PD-L1 inhibitors have demonstrated promising efficacy and safety in treating lung cancer patients with brain metastases, as evidenced by significant improvements in OS, PFS, and response rates. Incorporating PD-1/PD-L1 inhibitors into the treatment regimen, particularly for patients with high PD-L1 expression, has the potential to improve clinical outcomes in this patient population.

Hydatid cyst is a disease caused by Echinococcus granulosus parasite and a common zoonotic infection between humans and animals, with increasing prevalence in Iran. Few studies have been conducted in Iran about its clinical epidemiology. This study by Latent class analysis (LCA), examined the patterns of patients based on clinical symptoms and signs, organs involved, and diagnosis approaches and the chi-square test was used to examine the relationship of these patterns with some epidemiologic variables. In this case series study of surveillance system of hydatid cyst of Mazandaran province in north Iran, all patients who were confirmed to have hydatid cysts between 2012 and 2022 (118 patients) were evaluated Liver, lung and belly were the most involved organs and belly pain, liver enlargement and chest pain were also the most common symptoms of the disease. Based on clinical signs and symptoms, patients were classified into two classes: " non-specific symptoms& sings with 49.2%” and " specific symptoms & sings with 50.8%”. Based on the involved organs, the patients were classified into 3 classes: “specific lung with 17.8%”, “non-specific organs with 13.6%” and “specific liver with 68.6%”. Based on diagnosis approaches, patients were classified into 3 classes, including “specifically CT-scan with 32.2%”, " specifically MRI with 33.9%” and “specifically X-ray with 33.9%”. More “specific symptoms & sings pattern” were seen in the “specifically liver class” (almost 60% of cases) and “non-specific organs class” (75% of cases). This study provides valuable insights into the clinical epidemiology of hydatid cyst.