On-admission and dynamic trend of laboratory profiles as prognostic biomarkers in COVID-19 inpatients

This large-scale study aimed to investigate the trend of laboratory tests of patients with COVID-19. Hospitalized confirmed and probable COVID-19 patients in three general hospitals were examined from March 20, 2020, to June 18, 2021. The confirmed and probable COVID-19 patients with known outcomes and valid laboratory results were included. The least absolute shrinkage and selection operator (LASSO) and Cox regression were used to select admittance prognostic features. Parallel Pairwise Comparison of mortality versus survival was used to examine the trend of markers. In the final cohort, 11,944 patients were enrolled, with an in-hospital mortality rate of 21.8%, mean age of 59.4 ± 18.0, and a male-to-female ratio of 1.3. Abnormal admittance level of white blood cells, neutrophils, lymphocytes, mean cellular volume, urea, creatinine, bilirubin, creatine kinase-myoglobin binding, lactate dehydrogenase (LDH), Troponin, c-reactive protein (CRP), potassium, and creatinine phosphokinase reduced the survival of COVID-19 inpatients. Moreover, the trend analysis showed lymphocytes, platelet, urea, CRP, alanine transaminase (ALT), and LDH have a dissimilar trend in non-survivors compared to survived patients. This study proposed a novel approach to find serial laboratory markers. Serial examination of platelet count, creatinine, CRP, LDH, and ALT can guide healthcare professionals in finding patients at risk of deterioration.

The Benefits and Implementation of Diffusion Tensor Imaging and Neural Fiber Tractography in Brain Surgery

Background and Aim: The methods to detect brain activation with functional MRI (fMRI), and MRI provide a way to measure the anatomical connections which enable lightning-fast communication among neurons that specialize in different kinds of brain functions. Diffusion tensor imaging (DTI) can measure the direction of bundles of the axonal fibers which are all aligned. Besides mapping white matter fiber tracts, these methods can enable us to detect and characterize white matter disorders in diseases. The objective of this narrative review is to overview current knowledge concerning DTI as one of the prominent popular MRI techniques that provide a planned tool for comprehensive, noninvasive, functional anatomy mapping of the human brain in both research and practical field. This review summarizes the DTI development in recent years concerning the specificity and utility of this technique in brain surgery. Methods and Materials/Patients: The significance of mapping the structure of white matter tracts, constructively the brain’s wiring by visualization and characterization of white matter fasciculi in two and three dimensions enables us to profound how different brain regions are connected and how diseases affect white matter and cause neurological problems. And we noted that while DTI proposes a potent tool to study and visualize white matter, it suffers from inherent artifacts and limitations. Additionally, some materials about the origin of the DTI signal and unique information on white matter and 3D visualization of neuronal tracts have been raised. Results: This article focuses on DTI modality and its computational techniques, and investigates significant considerations in this regard. Moreover, an inspection of the white matter structure and integrity of normal and diseased brains (e.g. multiple sclerosis, stroke, aging, dementia, schizophrenia, etc.) have been raised as a clinical application of tractography. Conclusion: The utilization of advances in diffusion-tensor (DT) imaging techniques considerably enables us to map the white matter tractography (WMT) in the normal brain. These techniques impress the operative decision in a surgical operation, especially concerning cerebral neoplasms. Also, it is possible to judge with the assistance of DTI in each subject.

Principles of Neuronavigation

Background and Aim: Numerous efforts have been made over the past century. Various innovation techniques are increasingly gaining attention and gradually establishing the foundation of recent significant developments in the world of neurosurgery, among which varied stereotactic neuro-navigation designs and other novel emerging systems are being developed every day. This narrative review aims to describe basic concepts in frameless stereotaxy and summarize the primary principles of neuronavigation and clarify basic characteristics, such as the accuracy of this technique (frameless navigation), and emphasize the importance of designing phantom. Methods and Materials/Patients: The application of brain images to steer the surgeon to a target in the brain by utilizing the stereotactic principle of co-registration of the patient with an imaging study that permits brain surgery to be fulfilled with greater safety and smaller incisions by providing precise surgical guidance of the location of intracranial pathology is highly noticeable. General uses of frameless stereotaxy are explained and common benefits are highlighted. It is genuinely inevitable to estimate the accuracy of these systems and discover sources of error. Results: The findings have provided considerable insight into recent findings on principles of frameless stereotactic surgery and novel developments for image-guidance systems. Conclusion: The unprecedented development of image guidance has been much discussed. As a concluding note, several determinants, including updated imaging/registration, ease of use, robotic instruments, automated registration of increased accuracy, and the program’s potential for expansion to other disciplines, are all under development for image guidance.

Androgenetic alopecia and COVID-19: Is there a clinical connection?

BACKGROUND

During the coronavirus disease 2019 (COVID-19) outbreak, multiple studies showed higher rates of severe infection in adults and specifically in male patients, which may be related to differences in androgen receptor (AR) expression. Androgenetic alopecia (AGA) is one of the AR expression manifestations.

AIM

To explore AGA severity as a possible risk factor for COVID-19 severity in hospitalized patients.

METHODS

A total of 164 subjects (116 men and 48 females) with confirmed COVID-19 in need of hospitalization were included in this study. An experienced dermatologist examined the correlation of clinical signs of COVID-19 severity with AGA types. For evaluation of the association between categorical variables and comparison of the mean age in three groups of COVID-19 patients, the Fisher's exact test and the analysis of variance were used.

RESULTS

Our cross-sectional study included 116 male patients (70.7%) with a median age of 65.5 (age range: 22-97) years. Among them, 13.8% required intubation, 15.5% needed intensive care unit (ICU) care, and 70.7% required inward hospitalization. The Hamilton-Norwood Scale (HNS) was as follows: HNS I 14.7%, HNS II 12.1%, HNS III 20.7%, HNS IV 19.8%, HNS IV 29.8%, HNS V 17.2%, HNS VI 13.8%, and HNS VII 1.7%. Also, 29.3% of the patients were female, possessing a median age of 72 (age range: 23-98) years. In this group, 8.3% required intubation, 6.3% required ICU care, and 85.4% needed inpatient ward admission care. The Ludwig Scale (LS) was as follows: LS I 52.1%, LS II 35.4%, and LS III 12.5%.

CONCLUSION

The severity of AGA type did not correlate with the severity of COVID-19 among hospitalized patients. Our results were in contrast with other research that suggested AGA severity as a marker of unfavorable outcomes of COVID-19.

Transverse myelitis after SARS-CoV-2 infection: Report of two cases with COVID-19

Transverse myelitis has been reported as a complication of COVID-19 in recent studies. Here, we report two cases of transverse myelitis related to COVID-19. Both patients underwent plasma exchange after being treated with antibiotics and corticosteroids which lead to the recovery of one of them.

Parkinson's disease patients may have higher rates of Covid-19 mortality in Iran

Background

Parkinson's disease (PD) patients may be at increased risk of Covid-19 mortality due to the nature of their disease or underlying conditions.

Method

The information of 12,909 Covid-19 patients who were hospitalized during the last eleven months were collected from the data depository of two referral university hospitals. Eighty-seven of these patients were diagnosed with PD, and thirty-one of these PD patients died because of Covid-19. 2132 other deaths occurred in these centers, related to Covid-19 of non-PD patients. Fisher exact test, Chi-square test, and Principle component analysis were used for statistical analysis.

Results

The mortality among PD patients and other hospitalized patients was 35.6% and 19.8%, respectively, and the difference between the mortality of these two groups was found to be statistically significant (p-value<0.01). The mean age of PD patients who passed away was 77.06 ± 7.46, and it was not significantly different from that of alive PD patients (p-value>0.05). Alzheimer's disease as an underlying condition was more frequent in deceased PD patients in comparison to survived PD patients, and this difference was found to be statistically significant (p-value<0.01).

Conclusion

PD patients possess a higher rate of Covid-19 mortality in comparison with other patients hospitalized for Covid-19. PD pathophysiology, advanced age, underlying conditions, and health systems’ efficacy may play an essential role in such an outcome.

Potential Sedative and Therapeutic Value of Dexmedetomidine in Critical COVID-19 patients

The coronavirus 2019 disease (COVID-19) is an ongoing outbreak of respiratory disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus can invade various tissues and organs, causing multiple organ dysfunctions. Critically ill COVID-19 patients may develop acute respiratory distress syndrome and pneumonia, which are the major causes of hypoxemic respiratory failure and death due to SARS-CoV-2 infection. Thus, ventilation support (invasive or noninvasive), has become a common practice in respiratory treatment of COVID-19 patients. Patients receiving mechanical ventilation usually require sedation to alleviate anxiety, pain and discomfort. On the other hand, current clinical reports have indicated that a significant number of COVID-19 patients require prolonged intensive care unit (ICU) care and ventilation, which increases the risk of delirium. Thus, selection of appropriate sedative medications during this period is of utmost importance. Dexmedetomidine (DEX) is a sedative, anxiolytic and analgesic agent that acts through the α2-adrenoceptor. Its sedative property is notable due to the lack of respiratory depression. In addition, its cytoprotective, immunoregulatory and anti-inflammatory properties have been well established in preclinical settings. Based on these features, a number of recent studies have proposed DEX as a beneficial sedative agent that simultaneously mitigates the excessive inflammation and protects vital body organs in patients with severe COVID-19. In current brief review, we aimed to discuss the therapeutic benefits of DEX in managing different indications of COVID-19.

A systematic review of anti-Entamoeba histolytica activity of medicinal plants published in the last 20 years

Amoebiasis has emerged as a major health problem worldwide. It is endemic in the present scenario is different and sub-tropical regions especially in Asia, Latin America and also in Africa. Causative of amoebiasis is a protozoan known as Entamoeba histolytica. We screened all the databases such as PubMed, Science Direct, Medline and Google Scholar by using the keywords ‘anti-Entamoeba histolytica activity of medicinal plants, anti-Entamoeba histolytica activity of herbal drugs, the anti-amoebic activity of natural drugs’. In the present study, we found 7861 articles, where all articles were screened for bias analysis and included 32 full-matching articles in total reporting the use of medicinal plants as a remedy for amoebiasis. Through these articles, we found 42 herbs having anti-amoebic activity. In bias analysis, we also found four articles under high bias risk. In our study, seven medicinal plants were concluded to possess the most potent anti-amoebic activity based on their IC50 value, which was less than 1 μg mL−1. On bias analysis, we found four articles with high bias risk, hence these studies can be repeated for better results.

Neurological Manifestations and their Correlated Factors in COVID-19 Patients; a Cross-Sectional Study

Introduction:

COVID-19 might present with other seemingly unrelated manifestations; for instance, neurological symptoms. This study aimed to evaluate the neurologic manifestations and their correlated factors in COVID-19 patients.

Methods:

This retrospective observational study was conducted from March 17, 2020 to June 20, 2020 in a tertiary hospital in Iran. The study population consisted of adult patients with a positive result for COVID-19 real-time reverse transcriptase polymerase chain reaction (RT-PCR) using nasopharyngeal swabs. Both written and electronic data regarding baseline characteristic, laboratory findings, and neurological manifestations were evaluated and reported.

Results:

727 COVID-19 patients with the mean age of 49.94 ± 17.49 years were studied (56.9% male). At least one neurological symptom was observed in 403 (55.4%) cases. Headache (29.0%), and smell (22.3%) and taste (22.0%) impairment were the most prevalent neurological symptoms, while seizure (1.1%) and stroke (2.3%) were the least common ones. Patients with neurological manifestations were significantly older (p = 0.04), had greater body mass index (BMI) (p = 0.02), longer first symptom to admission duration (p < 0.001) and were more frequently opium users (p = 0.03) compared to COVID-19 patients without neurological symptoms. O₂ saturation was significantly lower in patients with neurological manifestations (p = 0.04). In addition, medians of neutrophil count (p = 0.006), neutrophil-lymphocyte ratio (NLR) (p = 0.02) and c-reactive protein (CRP) (p = 0.001) were significantly higher and the median of lymphocyte count (p = 0.03) was significantly lower in patients with neurological manifestations.

Conclusion:

The prevalence of neurological manifestations in the studied cases was high (55.4%). This prevalence was significantly higher in older age, grated BMI, longer lasting disease, and opium usage.

A review study on the anti-trichomonas activities of medicinal plants

The parasitic diseases represent the most important health risk, especially in underdeveloped countries where they have a deep impact on public health. Trichomoniasis is a prevalent non-viral sexually transmitted disease, and a significant amount of new cases are identified each year globally. Furthermore, the infection is linked with serious concerns such as pregnancy outcomes, infertility, predisposition to cervical and prostate cancer, and increased transmission and acquisition of HIV. The therapy is restricted, adverse effects are often observed, and resistance to the drugs is emerging. Based on this, a new treatment for trichomoniasis is necessary. Natural products represent a rich source of bioactive compounds, and even today, they are used in the search for new drugs. Additionally, natural products provide a wide variety of leadership structures that can be used by the pharmaceutical industry as a template in the development of new drugs that are more effective and have fewer or no undesirable side effects compared to current treatments. This review focuses on the medicinal plants that possess anti-trichomonal activity in vitro or in vivo. An electronic database search was carried out covering the last three decades, i.e., 1990-2020. The literature search revealed that almost a dozen isolated phytoconstituents are being explored globally for their anti-trichomonal activity. Simultaneously, many countries have their own traditional or folk medicine for trichomoniasis that utilizes their native plants, as a whole, or even extracts. This review focuses mainly on the human parasite Trichomonas vaginalis. However, at some points mention is also made to Tritrichomonas foetus that causes trichomoniasis in animals of high veterinary and economical interest. We will focus on the plants and plant-based compounds and their anti-trichomonal activity. The literature search highlighted that there are abundant compounds that possess anti-trichomonal activity; however, in-depth in-vivo evaluation of compounds and their clinical evaluation has not been undertaken. There is a critical need for new anti-trichomonal compounds, and focused research on phytoconstituents can provide the way forward.

Clinical and Epidemiological Characteristics of Postdischarge Patients With COVID-19 in Tehran, Iran: Protocol for a Prospective Cohort Study (Tele-COVID-19 Study)

Background

COVID-19 was declared a pandemic on March 11, 2020. Given that the severe shortage of hospital beds has led to early discharge and insufficient patient education on home care routines and isolation protocols, the close follow-up of patients and their immediate relatives is an integral part of transitioning from hospital care to home care for patients with COVID-19.

Objective

We designed the Tele-COVID-19 prospective cohort to follow-up with COVID-19 patients in Tehran, Iran, and improve health care delivery and the recording of postdischarge patients’ clinical profiles.

Methods

All adult patients who were admitted to the COVID-19 wards of teaching hospitals in Tehran, Iran were eligible to participate in this cohort study. At baseline, patients were recruited from 4 major hospitals from March 9, 2020 to May 20, 2020. Telephone follow-ups, which were led by volunteer medical students, were conducted on postdischarge days 1-3, 5, 7, 10, and 14. We collected data on a range of sociodemographic, epidemiological, and clinical characteristics by using a standard questionnaire.

Results

Of the 950 patients with confirmed COVID-19 who were approached, 823 (response rate: 86.6%) consented and were enrolled into the cohort. Of the 823 participants, 449 (54.5%) were male. The mean age of participants was 50.1 years (SD 12.6 years). During the initial data collection phase, more than 5000 phone calls were made and over 577 reports of critical patients who were in need of urgent medical attention were recorded.

Conclusions

The Tele-COVID-19 cohort will provide patients with sufficient education on home care and isolation, and medical advice on care and the proper use of drugs. In addition, by preventing unnecessary hospital returns and providing information on household SARS-CoV-2 transmission as early as possible, this cohort will help with effective disease management in resource-limited settings.

International Registered Report Identifier (IRRID)

DERR1-10.2196/23316

The Effect of Percutaneous Laser Disc Decompression on Reducing Pain and Disability in Patients With Lumbar Disc Herniation

Introduction: As low back pain incidence is increasing, noninvasive modalities are gaining attention for their ability to achieve the best possible outcome with the least complications. Percutaneous laser disc decompression (PLDD) is currently popular for this purpose. This study aims to evaluate the effect of PLDD on disability and pain reduction in patients with lumbar disc herniation. Methods: Thirty patients were enrolled in this study. Spinal nerve blocks were conducted by laser discectomy single stage injection of a needle into the disc space. The nucleus pulposus of herniated discs were irradiated with laser in order to vaporize a small part of the nucleus pulposus of the intervertebral discs and reduce the voluminosity of diseased discs. Patients were treated with 1000 J of 980 nm diode laser with 5 W energy. In order to measure the severity of pain, visual analog scale (VAS) and also ODI (Oswestry Disability Index) were used. Data were analyzed using SPSS version 12. Results: Thirty patients participated in this trial including 11 men and 19 women with a mean age (SD) of 40.8 (10.8) years. The mean patients VAS score and ODI level before and after discectomy showed statistically significant differences. The mean VAS and ODI scores showed no statistical difference between males and females (P<0.05) and percutaneous laser discectomy decreased the VAS and ODI at both groups of patients similarly. Conclusion: We found the use of PLDD reduces pain and disability in patients as a noninvasive procedure.

Molecular detection and antimicrobial resistance of Aeromonas from houseflies (Musca domestica) in Iran

ABSTRACT Objective. This study aimed to report the molecular detection and antimicrobial resistance of Aeromonas among houseflies (Musca domestica) in Shahrekord and Isfahan provinces of Iran. Materials and methods. Flies were caught from household kitchens, cattle farms, animal hospitals, human hospitals, slaughter house and poultry farms and put in collection separate sterile tubes. Isolation was accomplished by culture of flies in alkaline peptone water followed by identification with Aeromonas-specific Polymerase Chain Reaction (PCR). Results. Out of 600 houseflies 73 (12.2%) were infected with Aeromonas spp. Significantly higher frequencies of Aeromonas were isolated in Shahrekord province (13.0%; 39/300) than in Isfahan province (11.3%; 34/300). The recovery frequencies of the organisms were significantly lower in kitchens as compared to those in cattle farms and hospital wards which were similar. Higher proportions of infected flies were obtained during summer whereas low proportions were obtained during winter. Conclusions. It is concluded that houseflies do harbor diarrheagenic pathogens, including Aeromonas especially during summer. The carried organisms are resistant to a number of antimicrobials at different levels. Thus, future plans aimed at stemming infections caused by these organisms should take flies into account. Control efforts of infections caused by this particular bacterium should therefore take into account Musca domestica.

Effects of Clonidine Premedication on Intraoperative Blood Loss in Patients With and Without Opium Addiction During Elective Femoral Fracture Surgeries

Background:

Opium is an addictive agent and one of the most common narcotics With great challenges of intraoperative hemodynamic instabilities.

Objectives:

The current study aimed to assess the effects of clonidine on intraoperative blood loss in patients with and without opium addiction in femoral fracture surgeries.

Patients and Methods:

In a randomized clinical trial, 160 candidates for elective femoral fracture operations under general anesthesia were divided into four groups of 40 subjects: group 1 (placebo 1), subjects without addiction received placebo 90 minutes before the operation; group 2 (placebo 2), patients with opium addiction received placebo as group 1; group 3 (Clonidine 1), patients without addiction received clonidine 90 minutes before the operation and group 4 (Clonidine 2), patients with opium addiction received clonidine as premedication.

Results:

Intraoperative blood loss in clonidine recipient groups, patients with and without addiction, was less than that of the placebos (both P values < 0.01) and the difference magnitude was higher in patients with opium addiction.

Conclusions:

Premedication with clonidine to decrease intraoperative blood loss can be more effective in patients with opium addiction than the ones without addiction.

Molecular detection and antimicrobial resistance of Pseudomonas aeruginosa from houseflies (Musca domestica) in Iran

BACKGROUND

Pseudomonas aeruginosa is a common bacterium that can cause disease in humans and other animals. This study was conducted to screen for molecular detection and antimicrobial-resistant P. aeruginosa in Musca domestica in different locations in the Iranian provinces of Shahrekord and Isfahan.

METHODS

Musca domestica were captured by both manual and sticky trap methods, during the daytime, from household kitchens, cattle farms, animal hospitals, human hospitals, slaughterhouses and chicken farms at random locations in Shahrekord and Isfahan provinces of Iran, and subsequently transported to the laboratory for detection of P. aeruginosa. In the laboratory, flies were identified and killed by refrigeration in a cold chamber at -20 °C, then placed in 5 mL peptone water and left at room temperature for five hours before being processed. Pseudomonas isolates were preliminarily identified to genus level based on colony morphology and gram staining, and their identity was further confirmed by polymerase chain reaction.

RESULTS

Overall blaTEM gene was recovered from 8.8 % (53/600) of the P. aeruginosa isolated from houseflies collected from the two provinces. A slightly higher prevalence (10.7 %; 32/300) was recorded in Shahrekord province than Isfahan province (7.0 %; 21/300). The locations did not differ statistically (p < 0.05) in bacterial prevalence in flies. Seasonal prevalence showed a significantly lower infection frequency during autumn.

CONCLUSIONS

Houseflies are important in the epidemiology of P. aeruginosa infections.

Effects of clonidine premedication upon postoperative shivering and recovery time in patients with and without opium addiction after elective leg fracture surgeries

BACKGROUND

Opium is a highly addictive agent and the most common narcotic often misused in Iran. The pharmacokinetic of anesthetic drugs in patients with opium addiction is one of the great challenges for anesthesiologists. Hemodynamic instability and postoperative side effects are of these challenges which should be managed correctly.

OBJECTIVES

In this study we aimed to assess the effects of clonidine upon post anesthesia shivering and recovery time in patients with and without opium addiction after general anesthesia to decrease the subsequent complications related to the shivering and elongation of recovery time.

PATIENTS AND METHODS

In a randomized clinical trial, 160 patients candidates for elective leg fracture operations under general anesthesia were studied in four groups of 40 patients: Group 1 (placebo 1) were patients without addiction who got placebo 90 minutes before the operation. Group 2 (placebo 2) were patients with opium addiction which received placebo as group 1. Group 3 (Clonidine 1) patients without addiction who got clonidine 90 minutes before the operation and group 4 (Clonidine 2) who were opium addicted ones which received clonidine as premedication.

RESULTS

None of the patients with and without addiction in clonidine groups had shivering after the operation but in placebo groups shivering was observed and the difference between clonidine and placebo groups was statistically significant (P < 0.01). Recovery time in clonidine groups of patients with and without addiction was less than placebo ones (both P < 0.01) which the magnitude of difference was higher in opium addicted than non-addicted patients (P = 0.04).

CONCLUSIONS

Premedication with clonidine in patients with and without opium addiction can be effective to decrease the incidence of shivering and recovery time after operation.

The effect of pretreatment with clonidine on propofol consumption in opium abuser and non-abuser patients undergoing elective leg surgery

OBJECTIVE

Clonidine, an alpha-2 adrenergic agonist, increases the quality of perioperative sedation and analgesia with a few side effects. This study was designed to assess the effect of clonidine premedication on the anesthesics used for elective below knee surgeries in opium abusers and non-abusers.

MATERIALS AND METHODS

In a randomized clinical trial, 160 patients were selected and assigned into four groups. Eighty patients among the opium abusers were divided randomly into clonidine and no clonidine groups, with 40 patients in each, and 80 among the non-abusers were again divided randomly into clonidine and no clonidine groups, with 40 patients in each group. All were anesthetized for elective orthopedic operation using the same predetermined method. The total administered dose of propofol and other variables were compared.

RESULTS

THE TOTAL PROPOFOL DOSE IN A DECREASING ORDER WAS AS FOLLOWS: Abuser patients receiving placebo (862 ± 351 mg), non-abuser patients receiving placebo (806 ± 348 mg), abuser patients receiving clonidine (472 ± 175 mg), and non-abuser patients receiving clonidine (448 ± 160 mg). Hence, a statistically significant difference was observed among the four study groups (P value for ANOVA = 0.0001).

CONCLUSION

Adding clonidine as a preoperative medication decreases the patient's anesthetic needs; this decrease was even more considerable on the anesthetic needs than the effect of opium abuse history on anesthetic dose.