The Effectiveness of Laboratory Parameters in Predicting the in-Hospital Mortality of Iranian Patients with Coronavirus Disease 2019 (COVID-19)

BACKGROUND

The novel coronavirus 2019-nCoV (now SARS-CoV-2) has spread globally and affected healthcare systems worldwide. Due to lack of long-term immunization and effective specific treatments for the COVID-19 disease, there is a need of identifying the patients who are at the risk of a fatal outcome, according to the available epidemiological data and laboratory parameters.

OBJECTIVE

Thus, we aimed to evaluate the prognostic value of epidemiological data and laboratory para-meters for in-hospital case fatality in patients with COVID-19.

MATERIALS AND METHODS

A retrospective cohort of patients with COVID-19 admitted to the Shahid Mostafa Khomeini Hospital of Ilam University of Medical Sciences from February 29 until March 29, 2020 was performed. Epidemiologic data and laboratory results were collected. Univariate and multivariate logistic regression models were performed to evaluate the prognostic value of the laboratory parameters for in-hospital death.

RESULTS

A total of 256 Iranian COVID-19 patients were included in the evaluation; 38 of them died, resulting in a in-hospital case-fatality rate of 14.8%. The univariate analysis showed that advanced age [OR=1.04, 95% CI: 1.02, 1.06, P=0.001], smoking [OR=4.041, 95% CI: 1.546-10.563, P=0.004], white blood cells [OR=0.941, 95% CI: 0.904-0.980, P =0.003] and hematocrit [OR=1.060, 95% CI: 1.009-1.113, P=0.020] were positively associated with the risk of a fatal outcome. Multivariate logistic regression analysis revealed that COVID-19 patients with an elevated white blood cell count and elevated hemoglobin level had 1% and 9% greater risk of an in-hospital death for each elevated unit [OR=1.07; 95 %CI: 1.024-1.088, P =0.002 and OR=1.379; 95% CI 0.064-1.788, P =0.015, respectively].

CONCLUSIONS

An increase in white blood cell count and an increase in hemoglobin level might be indepen-dent risk factors for in-hospital death in Iranian patients with COVID-19. Further studies are necessary in order to conferm the prognostic value of the variables discussed.

Physical and mental growth and development in children with congenital hypothyroidism: a case-control study

Introduction

The clinical complications of congenital hypothyroidism such as brain disorders are very subtle and are not recognizable in infancy period. They are recognizable when it is too late for treatment or prevention. General screening of newborns is effective in diagnosing congenital hypothyroidism and initiating initial treatment. The aim of this study is to compare the physical and mental growth pattern of children with congenital hypothyroidism with healthy ones.

Methods

This case–control study was performed on 34 patients and 68 healthy children who were matched in terms of inclusion and exclusion criteria. Children development screening test (ASQ), children development assessment test (Bayley), preschool Wechsler intelligence scale (WPPSI) and age and steps questionnaire of emotional social development (ASQ-SE) were completed by trained questioners. Data were analyzed using STATA software.

Results

The results indicated that there was no significant difference between the mean of verbal (P = 0.77), non-verbal (P = 0.81) and general (P = 0.66) IQ in permanent and transient patients and healthy individuals. Also, there was no significant difference between the mean of different ranges of ASQ test (including communication, delicate and large movements, problem solving and social) at 12 months and 42 months (P < 0.05). According to Bayley test, there was no significant difference between the cases (permanent and transient) and controls in the cognitive (P = 0.42) and expressive (P = 0.38) categories. The difference was significant in the perceptual (P = 0.011), large (P = 0.03) and delicate (P = 0.04) movements categories.

Conclusion

This study emphasized on the high effectiveness of neonate hypothyroidism screening program, so that the difference between 3.5 years old children with and without this disease has decreased significantly. Early diagnosis of the patients, while creating beneficial effects for patients and increasing quality of life, cause reduction in the long-term costs of the health system.

Sub-minimum inhibitory concentrations of biocides induced biofilm formation in Pseudomonas aeruginosa

It is clear that biofilm formation causes many serious health-care problems. Interestingly, sub minimum inhibitory concentrations (sub-MICs) of some biocides can induce biofilm formation in bacteria. We investigated whether sub-MICs of Savlon, chlorhexidine and deconex®, as biocidal products, can induce biofilm formation in clinical isolates of Pseudomonas aeruginosa. To determine MICs and biofilm formation, we performed microtitre plate assays. All three biocides induced biofilm formation at sub-MICs; Savlon was the most successful antiseptic agent to induce biofilm formation among P. aeruginosa isolates. Deconex had the best inhibition effect on planktonic cultures of P. aeruginosa isolates. We concluded that sub-MICs of Savlon and deconex could significantly induce biofilm formation.

Asymptomatic carriers of Neisseria meningitidis and Moraxella catarrhalis in healthy children

There is a close correlation between asymptomatic oropharyngeal colonization by bacterial pathogens and paediatric respiratory diseases. Evaluation of the frequency of asymptomatic carriers of Neisseria meningitidis and Moraxella catarrhalis in healthy children was the main aim of the current study. In this cross-sectional study, 123 oropharyngeal swabs were collected from children between 2 and 6 years old in kindergartens of Ilam, Iran. Moraxella catarrhalis and N. meningitidis were identified using phenotypic and genotypic assays. In addition, the occurrence of the virulence factors (ctrA and uspA1) and iron uptake (tbpA) genes was evaluated by PCR. Results showed that 21 M. catarrhalis isolates and 17 N. meningitidis isolates were identified by conventional microbiological and biochemical methods, but the RT-PCR assay detected that 18 and 8 isolates were positive for M. catarrhalis and N. meningitidis, respectively. The tbpA gene was positive in all N. meningitidis and M. catarrhalis isolates. Seven isolates were positive for the ctrA gene in N. meningitidis and seven isolates were positive for the uspA1 gene in M. catarrhalis. These pathogenic bacteria often occurred as asymptomatic carriage of N. meningitidis in children from large families with low economic status, which reflects the importance of the environment and socio-economic level of families in the distribution of these potentially pathogenic bacteria in the oropharynx of children. Monitoring for the carriage of potential pathogenic bacteria in the nasopharynx of healthy children is important as this can predispose to infectious diseases; common exposure to human respiratory bacterial pathogens is a further risk factor.

Rapid and direct molecular detection of Streptococcus pneumoniae and Haemophilus influenzae isolated in oropharynx and nasal cavity of children

There is a direct correlation between asymptomatic oropharyngeal colonization by pathogenic bacteria and the prevalence of paediatric respiratory infections. Streptococcus pneumoniae and Haemophilus influenzae are common cause of serious bacterial infections such as meningitis in children. This study aimed to monitor healthy children to detect asymptomatic carriers of S. pneumoniae and H. influenzae. In the present cross-sectional study, real-time PCR assay was developed and evaluated in comparison with culture for direct detection of S. pneumoniae and H. influenzae in 123 oropharynx and nasal cavity specimens from healthy children in Ilam, Iran. In addition, virulence factor (ply and hpd) and iron uptake (tbpA and piuA) genes were evaluated by PCR. Our results demonstrated that among all isolates only 14 S. pneumoniae and eight H. influenzae were identified by phenotypic methods, whereas 37 and 21 S. pneumoniae and H. influenzae were identified, respectively, by real-time PCR assay. All S. pneumoniae and H. influenzae isolates possessed tbpA and piuA genes. Also, 81% (30/37) of S. pneumoniae isolates were positive for ply gene, which encoded pneumolysin, as well as 90% (19/21) of H. influenzae isolates were positive for hpd gene. Simultaneous colonization of S. pneumoniae and H. influenzae could indicate the importance of monitoring of healthy children to identification of carriers.

Increase in RNASEL gene expression by miR-29-3p inhibitors in HEK293T cells

BACKGROUND

RNase L is known as a terminal component of antiviral and Interferon (IFN) pathways in mammalian cells. On the other hand, the human miR-29 family of microRNAs (miRs) has three mature members, miR-29a, miR-29b, and miR-29c. miR-29 is encoded by two gene clusters and the family members have multifunctional roles in various biological processes.

OBJECTIVES

To determine the potential role of miR-29 in the regulation of RNASEL gene expression by designing inhibitors against its targeting miRNA, miR-29a-3p and evaluate the RNase L expression.

MATERIAL AND METHODS

After selecting miR-29a-3p as a main regulating miRNA for RNASEL in silico, two inhibitors were designed against it and synthesized. Synthesized strands were made double-stranded DNA oligos, treated with T4 polynucleotide kinase (PNK), cloned into the pCDH-CMV-MCS-EF1-cGFP-T2A-Puro vector and transformed into DH5&#945;. Colony PCR and sequencing was done for affirmation. Then the miR-29a-3p inhibitors were transfected into HEK-293T cell line and RNASEL gene expression was analyzed.

RESULTS

The miR-29a-3p inhibitors decreased miR-29a-3p expression in vitro. In addition, miR-29a-3p expression reduction resulted in an increase of RNASEL gene expression.

CONCLUSIONS

miR-29a-3p inhibitors could increase in RNASEL gene expression which potentially affects the antiviral/IFN pathway. The inhibitors could be considered as drug candidates in different diseases especially viral infections.

Online Estimation of Elbow Joint Angle Using Upper Arm Acceleration: A Movement Partitioning Approach

Estimating the elbow angle using shoulder data is very important and valuable in Functional Electrical Stimulation (FES) systems which can be useful in assisting C5/C6 SCI patients. Much research has been conducted based on the elbow-shoulder synergies. The aim of this study was the online estimation of elbow flexion/extension angle from the upper arm acceleration signals during ADLs. For this, a three-level hierarchical structure was proposed based on a new approach, i.e. 'the movement phases'. These levels include Clustering, Recognition using HMMs and Angle estimation using neural networks. ADLs were partitioned to the movement phases in order to obtain a structured and efficient method. It was an online structure that was very useful in the FES control systems. Different initial locations for the objects were considered in recording the data to increase the richness of the database and to improve the neural networks generalization. The cross correlation coefficient (K) and Normalized Root Mean Squared Error (NRMSE) between the estimated and actual angles, were obtained at 90.25% and 13.64%, respectively. A post-processing method was proposed to modify the discontinuity intervals of the estimated angles. Using the post-processing, K and NRMSE were obtained at 91.19% and 12.83%, respectively.

Oral potassium supplementation for management of essential hypertension: A meta-analysis of randomized controlled trials

IMPORTANCE

Increased dietary potassium intake is thought to be associated with low blood pressure (BP). Whether potassium supplementation may be used as an antihypertensive agent is a question that should be answered.

OBJECTIVE

To assess the effect of oral potassium supplementation on blood pressure in patients with primary hypertension.

SEARCH METHODS

We searched Medline, Web of Science, Scopus, Cochrane Central Register of Controlled Trials until October 2016. We also screened reference lists of articles and previous reviews. We applied no language restrictions.

SELECTION CRITERIA

We included randomized placebo-controlled clinical trials addressing the effect of potassium supplementation on primary hypertension for a minimum of 4 weeks.

DATA COLLECTION AND ANALYSIS

We extracted data on systolic and diastolic BP (SBP and DBP) at the final follow-up. We explored the heterogeneity across studies using Cochran's test and I2 statistic and assessed the probability of publication bias using Begg's and Egger's tests. We reported the mean difference (MD) of SBP and DBP in a random-effects model.

RESULTS

We found a total of 9059 articles and included 23 trials with 1213 participants. Compared to placebo, potassium supplementation resulted in modest but significant reductions in both SBP (MD -4.25 mmHg; 95% CI: -5.96 to -2.53; I2 = 41%) and DBP (MD -2.53 mmHg; 95% CI: -4.05 to -1.02; I2 = 65%). According to the change-score analysis, based on 8 out of 23 trials, compared to baseline, the mean changes in SBP (MD -8.89 mmHg; 95% CI: -13.67 to -4.11) and DBP (MD -6.42 mmHg; 95% CI: -10.99 to -1.84) was significantly higher in the intervention group than the control group.

CONCLUSIONS

Our findings indicated that potassium supplementation is a safe medication with no important adverse effects that has a modest but significant impact BP and may be recommended as an adjuvant antihypertensive agent for patients with essential hypertension.

Design, simulation and modelling of auxiliary exoskeleton to improve human gait cycle

Exoskeleton is a walking assistance device that improves human gait cycle through providing auxiliary force and transferring physical load to the stronger muscles. This device takes the natural state of organ and follows its natural movement. Exoskeleton functions as an auxiliary device to help those with disabilities in hip and knee such as devotees, elderly farmers and agricultural machinery operators who suffer from knee complications. In this research, an exoskeleton designed with two screw jacks at knee and hip joints. To simulate extension and flexion movements of the leg joints, bearings were used at the end of hip and knee joints. The generated torque and motion angles of these joints obtained as well as the displacement curves of screw jacks in the gait cycle. Then, the human gait cycle was simulated in stance and swing phases and the obtained torque curves were compared. The results indicated that they followed the natural circle of the generated torque in joints with a little difference from each other. The maximum displacement obtained 4 and 6 cm in hip and knee joints jack respectively. The maximum torques in hip and knee joints were generated in foot contact phase. Also the minimum torques in hip and knee joints were generated in toe off and heel off phases respectively.

The flavor and acceptability of six different potassium-enriched (sodium reduced) iodized salts: a single-blind, randomized, crossover design

Background

Hypertension is a serious public health problem. Potassium-enriched salt is suggested as a tool for lowering blood pressure. However, its flavor and taste acceptability is essential for population-based salt reduction strategy and needs to be well-understood. This trial assessed the flavor and taste acceptability of six different potassium-enriched iodized salts in the general population.

Methods

We conducted this crossover trial from May to June 2016, enrolling 100 normal volunteer subjects aged 11 to 64 years. We compared regular sodium chloride salt (placebo) with six different potassium-enriched (sodium reduced) iodized salt (experiment), including 0 %, 5 %, 10 %, 15 %, 20 %, 25 %, and 30 %. The participants served as their own control and received a placebo and a sequence of the experiments. They tasted the two salts sequentially and stated their preference and acceptance. Each subject received all salts.

Results

More than 80 % of participants who either did not distinguish between the two salts even in high potassium-enriched salts or preferred potassium-enriched salt (P < 0.001). The number of participants who preferred the flavor of potassium-enriched salt was greater than the number of subjects who preferred the flavor of regular sodium chloride.

Conclusion

Our findings indicated that the six different potassium-enriched salts had a public acceptability of at least 80 % among normal subjects from the general population. Although the acceptability of the potassium-enriched salts by a more general population group would require to be confirmed, universal use of this salt may help us achieve the target of 30 % relative reduction in mean population intake of sodium by 2025.

Solar degradation of Direct Blue 71 using surface modified iron doped ZnO hybrid nanomaterials

This paper reports photodegradation of Direct Blue 71 under irradiation by sunlight. We synthesized Fe:ZnO nanomaterials under mild hydrothermal conditions (P = autogenous, T = 100 °C, t = 18 h). The precursors were Fe(2)O(3) as dopant, n-butylamine as surface modifier, NaOH as mineralizer and reagent grade ZnO. The systematic experiments on the photodegradation of Direct Blue 71 were carried out by changing different effective parameters. The variables in this study were type of nanomaterials synthesized (4 types), nanomaterial dosage (0.4-1.0 g/L), contact time (30-120 min), pH (3-11), and dye concentration (20-100 ppm). The photodegradation efficiency was determined using a UV-Vis spectrophotometer. Determination of total organic carbon (TOC) amount was used to find out mineralization efficiency. Our experimental results revealed that the nanomaterials synthesized had higher efficiency compared with the reagent grade ZnO. The best efficiency was achieved at the following conditions: 1.0 g/L nanomaterials loading, 120 min contact time, pH 5, and photodegradation efficiency from more than 75 up to 99% depending upon the dye concentration.

Pre-Hospital Emergency Medical Services in Developing Countries: A Case Study about EMS Response Time in Yazd, Iran

BACKGROUND

Prehospital emergency medical services, a subsystem of Emergency Medical Services (EMS),provides early care to critically ill and injured patients in the field. Time is an important factor in pre-hospital care and the length of time it takes to reach care, has a significant impact on patient outcome. This study aims to calculate the response time in EMS stations of Yazd, Iran.

METHODS

During 2008-2009, 11961 run report forms from all 7 EMS stations in Yazd that had been submitted to central station were surveyed. By using Excell statistical software and descriptive statistics (percent, cumulative distribution and standard deviation), we calculated fractile response times for Yazd EMS.

RESULTS

81.15 percent of response times were within 8 minutes as a referenced standard for EMS.

CONCLUSION

The majority of call services in Yazd EMS have been responded in a suitable time interval comparing with reference standards and country's approved EMS response time goal, but there are still rooms for improvement.

Multi-trace elements level in drinking water and the prevalence of multi-chronic arsenical poisoning in residents in the west area of Iran

First, we determined the levels of 8 trace elements (As, Se, Hg, Cd, Ag, Mn, Cr and Pb) in 530 village drinking water sources by graphite furnace or flame atomic absorption spectroscopy method, in Kurdistan Province in the west of Iran. The results showed that the level of As, Cd and Se in 28 village drinking water sources exceeded WHO or National Standard limits. The levels of concentration of arsenic in drinking water ranged from 42 to 1500microg/L. Then in a cross-sectional survey, 587 people from 211 households were chosen for clinical examinations of multi-chronic arsenical poisoning including pigment disorders, keratosis of palms and soles, Mee's line in fingers and nails and the gangrene as a systemic manifestation. Of 587 participants, 180 (30.7%) participants were affected by representing the type of chronic arsenical poisoning. The prevalence of Mee's line, keratosis, and pigment disorders were 86.1%, 77.2% and 67.8% respectively. Therefore, the prevalence of Mee's line between inhabitants was higher than the other disorders. The results show a strong linear relationship between arsenic exposure and occurrence of multi-chronic arsenical poisoning (R(2)=0.76). The association between age for more than 40 years and gender for more than 60 years with chronic arsenical poisoning is significant (p<0.05). Also, there is a relationship between subjects who were affected with disorders and duration of living in the village. Except for gangrene disorder, the odds ratio of prevalence of other disorders with arsenic exposure level in drinking water show a highly significant relationship between arsenic content and the risk of chronic disorders (p<0.01). These results confirm the need to further study trace elements in drinking waters, food products and other samples in this area and the relationship to other chronic diseases arising out of arsenicosis.

The prevalence of coronary artery disease in an urban population in Isfahan, Iran

OBJECTIVE

Cardiovascular diseases, especially coronary artery disease (CAD), are responsible for the highest mortality rate in Iran. This study was conducted to determine the prevalence of CAD in an urban sample in Isfahan by the Minnesota code of a 12-lead resting electrocardiogram (ECG), the Rose questionnaire on chest pain and a self-reported previous medical history.

METHODS AND RESULTS

Among the target sample of 6,470 men and women aged 35-79 years who were randomly selected from 80 random clusters in Isfahan, 5,773 subjects (about 90%) have participated. The WHO (Rose) questionnaires (Q) on chest pain were completed for all participants and 12-lead ECGs were taken. The overall prevalence of CAD based on the Rose Q and/or ECG was 19.4% (95% CI 18.4% to 20.4%) which was significantly higher among women 21.9% (95% CI 20.5% to 23.3%) than men 16.0% (95% CI 14.5% to 17.5%) (p < 0.05). The prevalence of CAD increased with age in both sexes. The prevalence of definite and possible angina based on the questionnaire was higher among women compared to men (p < 0.05), also a greater prevalence of ECG-based possible ischaemia was observed among woman than men (12.3% vs. 7.5%) (p < 0.05). However, definite and possible MI and definite ischaemia based on ECG abnormalities were higher among men than women (p < 0.05). The total prevalence of symptomatic CAD was 9.3% and about 22% of those with symptoms of CAD on Q have some evidence on ECG. The findings also showed that CAD is more common among people with less education, lower income and the unemployed (p < 0.05).

CONCLUSION

These findings indicate that there is a high prevalence of CAD among the Iranian population which need more programmes of health promotion and lifestyle changes and further studies to assess the used epidemiological methods for estimating CAD prevalence, especially among women.