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This study aimed to assess the efficacy of ezetimibe in combination with metformin versus metformin alone in patients with metabolic dysfunction-associated fatty liver disease (MAFLD) and type 2 diabetes mellitus. Patients were randomly divided into two groups: one receiving ezetimibe and metformin (Met + EZY) and the other receiving metformin alone (Met group) for six months. Parameters were measured at baseline (T1), after three months (T2), and after six months (T3). The findings indicated that insulin levels and HOMA-IR exhibited a significant decrease from T1 to T2 in the Met + EZY group ( p  < 0.05). Malondialdehyde (MDA) and triglycerides levels also demonstrated significant decreases from T1 to T2 in the Met + EZY group ( p  < 0.05). The expression of peroxisome proliferator-activated receptor gamma ( PPAR-γ ) and adiponectin ( ADIPO ) showed a significant increase from T1 to T2 in the Met + EZY group ( p  < 0.01). Additionally, ADIPO expression showed a significant increase from T1 to T3 ( p  < 0.001) in both groups. When comparing the two treatment groups, PPAR-γ and ADIPO expression were significantly higher in the Met + EZY group during T2 and T3 compared to the Met group ( p  < 0.001). Combination therapy appears to be more effective than metformin treatment alone and should be used cautiously.

This systematic review and meta-analysis aimed to overview the observational studies on the association of exposure to air pollution and type 1 diabetes mellitus (T1DM). Based on PRISMA guidelines, we systematically reviewed the databases of PubMed, Scopus, Embase, and Web of Science databases to determine the association of air pollution exposure and T1DM. Quality assessment of the papers was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for observational studies. The odds ratios (OR) and their 95% confidence intervals (CI) were calculated to assess the strength of the associations between air pollutants (gases and particulate matter air pollutants including PM10, PM2.5, NO2, volatile organic compound, SO4, SO2, O3) and T1DM. Out of 385 initially identified papers, 6 studies were used for this meta-analysis. Fixed effects meta-analysis showed a significant association between per 10 μg/m increase in O3 and PM2.5 exposures with the increased risk of T1DM (3 studies, OR = 1.51, 95% CI: 1.26, 1.80, = 83.5% for O3 and two studies, OR = 1.03, 95% CI: 1.01, 1.05, = 76.3% for PM2.5). There was no evidence of association between increased risk of T1DM and exposure to PM10 (OR = 1.02, 95% CI: 0.99-1.06, = 59.4%), SO4 (OR = 1.16, 95% CI: 0.91-1.49, = 93.8%), SO2 (OR = 0.94, 95% CI: 0.83-1.06, = 85.0%), and NO2 (OR = 0.995,95% CI: 1.05-1.04, = 24.7%). Recent publications indicated that exposure to ozone and PM2.5 may be a risk factor for T1DM. However, due to limited available studies, more prospective cohort studies are needed to clarify the role of air pollutants in T1DM occurrence.

Breast carcinoma is the most frequent cancer among women with considerable invasive and metastatic behavior. CCND1, the oncogene encoding cyclin D1, is amplified in a substantial proportion of human cancers. Although cyclin D1 overexpression has been reported in up to 50% of human breast cancers, its prognostic impact on breast carcinoma is still controversial. In this cross-sectional investigation, 89 patients with breast invasive ductal carcinoma enrolled in the study. Tumor tissue samples were stained immunohistochemically for cyclin D1. The marker was semiquantitatively scored using the Allred scoring method and its relationship with ER, PR, and HER2-neu status as well as age, tumor grade and stage was then determined. Cyclin D1 was strong (S), intermediate (I), weak (W), and negative (N) in 19.1%, 44.9%, 14.6%, and 21.3% of the cases, respectively. Estrogen receptor (ER), progesterone receptor (PR), and HER2- neu were positive in 60.7%, 58.4%, and 36% of the cases, respectively. There was a statistically significant reverse relationship between tumor grade and cyclin D1 (P = 0.009). The relationship between cyclin D1 and both hormone receptors was also statistically significant (P = 0.0001). There was no statistically significant relationship between cyclin D1 on one hand and age, stage, and HER2-neu on the other (P > 0.05). The reverse relationship between cyclin D1 overexpression and tumor grade as well as its positive relationship with ER and PR in invasive ductal carcinoma suggest that cyclin D1 may directly or indirectly result in maturation and differentiation of tumor cells.

BACKGROUND Dry cough is a prevalent symptom of COVID-19. During the pandemic, people may mistake this cough for symptoms associated with other respiratory diseases. This increases the risk of individuals with a cough being falsely judged as having COVID-19. This study aimed to investigate the impact of coughing in public places on adults’ mental and social well-being during the COVID-19 pandemic and to explore the role of demographic factors in the relationship between coughing and psychosocial life in public places in the western region of Saudi Arabia. METHODS This cross-sectional study was conducted in the western region of Saudi Arabia, targeting healthy adults aged ≥18 years. The participants were randomly selected using a cluster sampling technique. Data were collected through a self-administered validated questionnaire to explore the psychosocial impact of coughing in public places during the COVID-19 pandemic. Additionally, the questionnaire collected demographic information, smoking habits, cough frequency, consumption of cough medications, history of mild respiratory diseases, and family history of chronic respiratory illnesses. The mean and standard deviation were used to calculate continuous variables, and frequency and percentages were used to present categorical variables. We analyzed the relationships between study variables using the analysis of variance test. RESULTS 288 adults participated in the study, with a 67.2% agreement score. 82.0% of the participants avoided people who coughed in public, while 51.8% felt angry and frustrated when someone coughed in public during the pandemic. CONCLUSIONS COVID-19 has changed how people react to coughing in public. Mild coughs can be mistaken for COVID-19, leading to avoidance.

Rosai-Dorfman disease is a benign lymphohistiocytosis that often involve lymph nodes and present as massive lymphadenopathy with sinus histiocytosis. The disease is rarely associated with intracranial involvement. Herein, we report a 33-years-old man with recent onset of unconsciousness. According to his past medical history, he was suffering from frontal headache, ataxia and dizziness with no sensory or motor defect since August 2010. At initial work up, MRI showed infiltrating mass in the left parietal region. Microscopically, the mass consisted of infiltration of abundant lymphoplasma cells, neutrophils and some histiocytes scattered in fibrotic background. Emperipolesis (lymphocytophagocytosis) of histiocytic cells made the diagnosis of Rosai-Dorfman disease. Rosai-Dorfman disease should be added in the list of differential diagnosis for a dural mass mimicking meningioma or cerebral mass mimicking glioma, therefore, immunohistochemical staining for EMA, S100 and CD1a should be performed to rule out the differential diagnosis.

Background: Features of malignant melanoma (MM) vary in the different geographic regions of the world. This may be attributable to environmental, ethnic, and genetic factors. The aim of this study was to determine the expression of estrogen receptor alpha (ER-α) in MM in Isfahan, Iran. Materials and Methods: This study was planned as a descriptive, analytical, cross-sectional investigation. During this study, paraffin-embedded tissue blocks of patients with a histopathologic diagnosis of MM was studied for ER-α using immunohistochemistry (IHC). Results: In this study, 38 patients (female/male; 20/18) with a definite diagnosis of malignant cutaneous melanoma and mean age of 52.4 ± 11.2 years were investigated. Using envision IHC staining, there were not any cases with ER-α expression. Conclusion: In confirmation to the most previous studies, expression of ER-α was negative in MM. It is recommended to investigate the expression of estrogen receptor beta and other markers in MM.

Leiomyoma is benign mesenchymal tumor, that frequently occur in uterus but it rarely happens in ovary. Ovarian leiomyomas are seen concomitantly with uterine leiomyoma in about 78% of cases. They often discover incidentally but their most clinical manifestations are abdominal pain and palpable mass. Herein, we reported a large ovarian leiomyoma in a 22-year-old woman with abdominal pain and palpable mass at lower abdominal region. Computed tomography scan revealed large adnexal mass. Microscopic appearance was typical for leiomyoma but because its rarity in ovary the immunohistochemical staining was done. Major differential diagnostic considerations for this tumor in ovary are fibroma/thecoma, sclerosing stromal tumor, and leiomyosarcoma. The immunohistochemical staining with desmin, inhibin, and α-smooth muscle actin are helpful to rule out this differential diagnosis.

Inflammatory pseudotumor (IPT) is an uncommon tumor and its occurrence in spleen is rare. This tumor is composed of proliferation of spindle cells of unknown origin and etiology that mimic other tumors at clinical and histological evaluation. The most surmising etiology is Epstein Barr virus (EBV) and the most suspected origin is myofibroblasts, hence its synonym is \"inflammatory myofibroblastic tumor.\" The clinical appearance of tumor is related to its location but the most ones are abdominal pain, fever and weight loss. Surgical removal for this lesion is treatment of choice and there is few reported case with recurrence and metastasis. Herein we report a 63-year-old female patient with and abdominal discomfort that primary paraclinical investigations had been showed splenic mass and therefore surgical treatment was performed for her. Microscopic examination suggest some different diagnosis such as IPT, thus immunohistochemical staining was perform to confirm the diagnosis and rule out the others.

Signet ring carcinoma is a common type of adenocarcinoma of stomach but its occurrence in ampulla of Vater is extremely rare. There are only a few previous reported cases of signet ring carcinoma of ampulla of Vater. Here we reported a 61-year-old woman with obstructive jaundice. Ultrasonography and computed tomography (CT scan) examination showed intra- and extrahepatic bile duct dilatation. Endoscopic examination with biopsies revealed a small-size mass in ampulla of Vater with diagnosis of signet ring carcinoma. On consequent pancreatoduodenectomy the tumor was diagnosed as T2N0M0, stage IB. Because of the specific site of signet ring carcinoma of ampulla of Vater, the tumor seems to present itself at an early stage of disease. We review in the literature to suggest our idea.

Cd is a toxic metal that has a destructive impact on most organ systems. This work aims to determine Zn or Mg protective effects against Cd renal toxicity. In this study, rats were divided into six groups. The Cd group was treated with 1 mg Cd/kg, and the control group received 0.5 cm 3 normal saline, intraperitoneally. The other four groups received one of the following dosages of 1 mg/kg Cd + 0.5 mg/kg Zn, 1 mg/kg Cd + 1.5 mg/kg Zn, 1 mg/kg Cd + 0.5 mg/kg Mg, or 1 mg/kg Cd + 1.5 mg/kg Mg through IP injection for 3 weeks. Kidney malondialdehyde (MDA) and serum sodium, potassium, urea, creatinine, and protein were measured. Light microscopic examination was used for histological studies. Cd reduced serum creatinine and protein, and increased urea, sodium, and potassium. Moreover, Cd exposure caused a significant enhancement in MDA levels as well as histological damage in kidneys. Zn or Mg treatment prevented and reversed toxic alterations induced by Cd. These results suggest that Zn and Mg may have protective effects against Cd renal toxicity.