The demographic, clinical, and medical manifestations of pulmonary thromboembolism development in COVID-19

Background@#Since the emergence of coronavirus disease 2019 (COVID-19), various clinical manifestations ranging from asymptomatic to severe, life-threatening courses have been presented. It is well known that COVID-19 patients are at an increased risk of pulmonary thromboembolism (PTE) development; however, the associated demographic, medical, and clinical factors for developing PTE remain unknown. The current study aimed to assess the characteristics of patients with PTE. @*Methods@#This case-control study was derived from an ongoing population-based investigation of hospitalized patients with COVID-19 pneumonia. The case group included 99 patients with PTE confirmed by computed tomography pulmonary angiography (CTPA), and the controls (N=132) were age-matched patients selected from the PTE-suspected patients with a negative CTPA. The demographic, medical, and clinical characteristics of the study population were entered into the study checklist and compared. A logistic regression test was used to determine the factors associated with PTE development. @*Results@#Among the 13,099 admitted patients, 690 (5.26%) were suspected of having PTE according to their clinical manifestations. CTPA was performed for suspected cases, and PTE was confirmed in 132 patients (19.13%). Logistic regression assessments revealed that male gender (OR, 2.39; 95%CI, 1.38‒4.13), decreased oxygen saturation (OR, 2.33; 95%CI, 1.27‒4.26), and lower hemoglobin (OR, 0.83, 0.95), and albumin (OR, 0.31; 95%CI, 0.18‒0.53) levels were associated with PTE development. @*Conclusion@#PTE was confirmed in one-fifth of suspected patients who underwent CTPA imaging. Male sex, decreased oxygen saturation, and lower levels of hemoglobin and albumin were independent predictors of PTE in patients with COVID-19 pneumonia.

Synergists action of piperonyl butoxide and S,S,S-tributyl phosphorotrithioate on toxicity of carbamate insecticides against Blattella germanica

Objective To determine the synergists action of piperonyl butoxide (PBO) and S,S,S-tributyl phosphorotrithioate (DEF) on toxicity of carbamate insecticides against Blattella germanica in Tehran city. Methods In the current study, German cockroach strains were collected from several hospitals and dormitories in Tehran. At the beginning, different concentrations of bendiocarb and carbaryl (insecticides belong to carbamate group) were determined by surface contact on a susceptible strain. Then, the level of susceptibility and type of resistance mechanisms in the collected strains from contaminated sites to the aforementioned insecticides were studied by using PBO and DEF synergists with different insecticide ratios to synergist (1:0, 1:1, 1:2, 1:3). Results The DEF synergist along with bendiocarb and carbaryl completely eliminated the resistance in all strains but PBO did not completely eliminate the resistance in the strains of Mofid, Alvand, Valiasr hospitals and Shariati dormitory. Generally, the impact of DEF was observed in the removing resistance more than PBO. Conclusions In most of these strains, resistance to bendiocarb and carbaryl is completely eliminated by DEF, showing a very high role of estraze enzymes in resistance to bendiocarb and carbaryl. But in most strains PBO does not remove the resistance because other mechanisms, such as reduced cuticle penetration and insensitivity to the acetylcholine esterase enzyme, may be involved.

Synergists action of piperonyl butoxide and S,S,S-tributyl phosphorotrithioate on toxicity of carbamate insecticides against Blattella germanica

OBJECTIVE@#To determine the synergists action of piperonyl butoxide (PBO) and S,S,S-tributyl phosphorotrithioate (DEF) on toxicity of carbamate insecticides against Blattella germanica in Tehran city.@*METHODS@#In the current study, German cockroach strains were collected from several hospitals and dormitories in Tehran. At the beginning, different concentrations of bendiocarb and carbaryl (insecticides belong to carbamate group) were determined by surface contact on a susceptible strain. Then, the level of susceptibility and type of resistance mechanisms in the collected strains from contaminated sites to the aforementioned insecticides were studied by using PBO and DEF synergists with different insecticide ratios to synergist (1:0, 1:1, 1:2, 1:3).@*RESULTS@#The DEF synergist along with bendiocarb and carbaryl completely eliminated the resistance in all strains but PBO did not completely eliminate the resistance in the strains of Mofid, Alvand, Valiasr hospitals and Shariati dormitory. Generally, the impact of DEF was observed in the removing resistance more than PBO.@*CONCLUSIONS@#In most of these strains, resistance to bendiocarb and carbaryl is completely eliminated by DEF, showing a very high role of estraze enzymes in resistance to bendiocarb and carbaryl. But in most strains PBO does not remove the resistance because other mechanisms, such as reduced cuticle penetration and insensitivity to the acetylcholine esterase enzyme, may be involved.

New aspects about Supella longipalpa (Blattaria: Blattellidae)

The brown-banded cockroach, Supella longipalpa (Blattaria: Blattellidae) (S. longipalpa), recently has infested the buildings and hospitals in wide areas of Iran, and this review was prepared to identify current knowledge and knowledge gaps about the brown-banded cockroach. Scientific reports and peer-reviewed papers concerning S. longipalpa and relevant topics were collected and synthesized with the objective of learning more about health-related impacts and possible management of S. longipalpa in Iran. Like the German cockroach, the brown-banded cockroach is a known vector for food-borne diseases and drug resistant bacteria, contaminated by infectious disease agents, involved in human intestinal parasites and is the intermediate host of Trichospirura leptostoma and Moniliformis moniliformis. Because its habitat is widespread, distributed throughout different areas of homes and buildings, it is difficult to control. Considering its possible resistance to insecticides, the control situation may be far more complex. For improved control of S. longipalpa an integrated pest management program is needed. Sanitation, indoor insecticide spraying in the initial cockroach control phase and insecticide formulation baits are recommended simultaneously.

[Evaluation of relationship between neonatal jaundice and incidence rate of congenital hypothyroidism in newborns at selected educational hospitals in Mashhad, Iran]

Congenital hypothyroidism [CH] is one of the most urgent diseases of the newborns; with preventable complications, such as mental retardation, by early diagnosing and treatment. It is often asymptomatic, but it can induce severe and or prolonged jaundice. We aimed to assess relationship between neonatal jaundice, as a nonspecific clinical sign, and incidence rate of CH. This cross-sectional study was performed on 140 healthy term newborns affected jaundice that admitted to 4 selected educational Hospital in Mashhad, Iran. As CH causes both prolonged and severe hyperbilirubinemia, all 1-28- day old newborns with various causes of jaundice with total serum bilirubin values of > 10 mg/dl were included and evaluated for thyroid function tests. Thyroid-stimulating hormone [TSH]> 10 mu/l and thyroxin [T4] <7 microg/dl were considered as CH. Serum value of T4 was normal at 97.86% and low at 2.14%. 1.43% of newborns had serum level of TSH >10 mu/l. More investigation reavealed the incidence rate of hypothyroidism at approximately 1 case in 140 birth which means 7 cases in 1000 birth [7:1000]. In present study, the incidence rate of CH was 7:1000. As usual, there is no clinical finding in CH at birth, so more attention should be paid to nonspecific signs of hypothyroidism that one of the earliest is severe or prolonged jaundice. Also, follow up should be considered for these newborns

Estimation of prevalence and incidence of sexually transmitted infections in Iran; a model-based approach

Background: Routine reporting of sexually transmitted infections [STIs] in Iran is one of the main information sources on STIs, endures some diminution under influence of several factors. We aimed to adjust registered STI data with a model-based approach and estimate the incidence and prevalence of STIs in Iran

Methods: In this cross-sectional study, we developed a stochastic compartmental model considering effects of influential factors on STI reporting process to adjust registered STI data. We reviewed literature and used Delphi method to collect data and estimate model parameters. We calibrated the model using Monte Carol simulation with 95% confidence interval [CI]. Finally, we validated the models by comparing their output with investigational data

Results: The estimated prevalence of male urethral discharge was 0.40% [95% CI: 0.26%, 0.65%]; the prevalence of genital ulcers was 3.68% [95% CI: 2.31%, 6.43%] in women and 0.16% [95% CI: 0.10%, 0.27%] in men. The estimated incidence for Neisseria gonorrhoeae, Chlamydia trachoma and syphilis per 1000 women was 2.44 [95% CI: 1.17, 6.65], 5.02 [95% CI: 2.78, 10.16] and 0.04 [95% CI: 0.02, 0.05] respectively; the corresponding figures per 1000 men were 0.43 [95% CI: 0.26, 0.80], 0.82 [95% CI: 0.42, 1.92] and 0.005 [95% CI: 0.003, 0.008]

Conclusions: Various factors are responsible for the obvious underestimation in the number of STIs registered in Iran. Notwithstanding this underestimation, our models offer an indirect method of estimating the prevalence of STIs in the country. Providing policymakers and STI experts with more realistic estimates might prompt policymakers and STI experts to recognize the importance of STIs in Iran and help them to develop appropriate prevention and control programs

N-acetylcysteine instead of theophylline in patients with COPD who are candidates for elective off-pump CABG surgery: is it possible in cardiovascular surgery unit?

Forced expiratory volume in one second [FEV1] is a good predictor of chronic obstructive pulmonary disease [COPD]. COPD is characterized by a chronic limitation of airflow. This study was designed to compare the effects and complications of theophylline alone, N-acetylcysteine [NAC] alone, and a combination of the two drugs on the rates of FEV1 in patients with COPD who were candidates for off-pump coronary artery bypass graft [CABG] surgery. This clinical trial was performed on 100 patients who had a smoking history of 27 pack years with a range of 20 to 40 pack years but were not heavy smokers and were candidates for elective off-pump CABG surgery in Afshar Cardiovascular Hospital, Yazd, Iran. The patients with a history of asthma and bronchospasm and non-COPD respiratory disorders were excluded. There were three groups, that is, the theophylline group [n=33] that received theophylline 10 mg/kg TDS after consumption of food, NAC group [n=33] who received NAC 10-15 mg/kg BD after consumption of food, and the combined group [n=32] who received theophylline and NAC together. Data were analyzed by analysis of variance [ANOVA], Chi-square, and exact test for quantitative and qualitative variables. One hundred patients with COPD enrolled in this study as possible candidates for CABG surgery. Average age of the patients was 60.36 +/- 10.21 years. Of the participants, 83 [83.3%] were male and 17 [17%] were female. Rate of postoperative FEV1 to basal FEV1 was 0.76 +/- 0.32, 0.66 +/- 0.22, and 0.69 +/- 0.24 in the treatments with theophylline, NAC, and the combination, respectively. Theophylline, NAC, and a combination of these drugs can decrease the rate of postoperative FEV1 compared to basal FEV1 significantly. [P=0.0001] Theophylline alone, NAC alone, and a combination of these drugs improve pulmonary function, and there are no significant differences between these protocols. Stomach discomfort and cardiac complications in treatment with theophylline alone is significantly higher than NAC alone and the combination

Modeling of human immunodeficiency virus modes of transmission in Iran

Main technique to control acquired immunodeficiency syndrome [HIV] infection is the effective preventive programs among high-risk groups. Modeling is one of the effective methods where there is inadequate data. We used the modes of transmission [MOT] model to predict the transmission of HIV infection in Iran. We systematically searched published and grey literature to find values for the input parameters of MOT in 2010. The data were discussed by experts before being fed into the model. Using the Monte Carlo simulation, we computed the 95% confidence interval [CI] for the outputs of the MOT. The MOT estimates that 9136 new HIV infections would have occurred in Iran in 2010 [95% CI: 6831, 11757]. About 56% [95% CI: 47.7%, 61.6%] of new infections were among intravenous drug users [IDUs] and 12% [95% CI: 9.5%, 15%] among their sexual partners. The major routes of direct and indirect HIV transmission in Iran are unsafe injection [68%] and unprotected sexual contact [34% unprotected heterosexual and 10% homosexual] respectively. If current coverage for safe injection among IDUs increases from 80% to 95%, new HIV infections in this group would decrease around 75%. IDUs remain at highest risk of HIV infection in Iran, so the preventive program coverage for IDUs and their spouses needs to be increased. As the sexual transmission of HIV contributes increasingly to the pool of new infections, serious measures such as harm reduction program are required to reduce sexual transmission of HIV among the relevant key populations.

[Comparison of PBO and DEF effects on creating bendiocarb and carbaryl insecticide resistance in German cockroach]

German cockroach [Blattella germanica, Blattodea:Blattellidae] is considered one of the common pests in hospitals, hotels, households and dormitories which can transfer different pathogenic fungi, viruses and bacteria. The aim of this study was to determine the resistance mechanisms to bendiocarb and carbaryl in German cockroache, in vivo. In this study, German cockroach strains were collected from several hospitals and dormitories in Tehran and transferred to insectarium. The strains were reared under the same laboratory conditions. At first the discriminative doses of bendiocarb and carbaryl were determined by surface contact method. Then the susceptibility level and types of resistance mechanisms to bendiocarb and carbaryl, in the strains were studied by using PBO and DEF as synergists. Simultaneous use of DEF as synergist, with bendiocarb and carbaryl led to the breakdown of resistance in all strains. But use of PBO instead of DEF did not overcome the resistance in the strains collected from Mofid, Alvand and Vali Asr hospitals and Shariati dormitory. In general, the effect of DEF in breaking the resistance was more than that of PBO. Complete breakdown of resistance after simultaneous use of DEF with bendiocarb and carbaryl insecticides, indicated the essential role of esterase enzymes in producing resistance to bendiocarb and carbaryl in the strains. But PBO did not break the resistance completely in most wild strains, which may be due to other possible mechanisms of resistance such as reduction of cuticle penetration or insensitivity to acetyl cholinesterase enzyme

[Measurement errors in medical research]

To address research questions, measuring variables are neccessary. However, every measurement is prone to different types of measurement errors. Therefore, understanding about the different types of measurement errors are a great of importance. This paper presents four types of measurement errors 1] Disagreement, which is discrepancies between the results of two or more than two measuring tools or observers 2] Random error which is a none-directional gap between the true and measured values 3] Systematic error or bias which is a directional gap between the true and measured values, and finally 4] Confounding error which changes the strength of association between dependent and independent variables in analytical studies

[Psychosis in three patients with vitiligo]

Psychotic disorders have been observed in association with some autoimmune disorders. Moreover, autoimmune mechanisms have been recently considered in evaluation of schizophrenia spectrum disease managements. Vitiligo is one of the autoimmune diseases, but there is no report of vitiligo association with psychosis. We report three patients with vitiligo and schizophrenia spectrum disease that are indicative of the role of autoimmunity in psychosis. Moreover, unusual manifestation and poor response to treatment in the reported cases show that autoimmunity can complicate the prognosis of psychosis

Human extensive head skin myiasis

Chrysomya bezziana Villeneuve is the most important fly, which produces myiasis, exists as an obligate ectoparasite in the animals, and afflicts human. Poor hygiene and working in contaminated areas particularly during warm seasons provide a situation to infest by this parasite. Infestation in human and livestock are often observed in wounds, normal body orifices such as eyes, ears, nose, and mouth. The manifestations include pruritus, pain, inflammation, redness, eosinophilia, and secondary bacterial infections and rarely death. A 5-year-old boy with severe headache and agitation symptoms was followed up. After physical examination and endoscopy, larvae of third instar fly were obtained from his scalp. Our precise identification indicated that the flies were the C. bezziana. This is the second report of the human scalp myiasis caused by C. bezziana in Iran. This study confirmed that the old world screwworm fly was distributed in the southern of Iran and probably could be one of the most important agents of myiasis in this area

Clinical short term outcome of Guillain-Barre syndrome in children

Several factors are useful in predicting the prognosis of Guillain-Barre syndrome [GBS]. The objective of this study was to determine the role of clinical presentation scaling to predict patient's short-term outcome. Forty five patients with the confirmed diagnosis of GBS, according to international diagnostic criteria, were enrolled in this study. All children who were not able to walk unaided [i.e., ordinal disability score=ODS >/= 3] were treated with intravenous immunoglobulin [IVIg] alone or with corticosteroid. The primary outcome measures were the degree of disability at discharge, length of hospital stay, need to intensive care setting and mortality. Male to female ratio was 1.05: 1 with mean age of 5.9 years. The most common manifestation was limb weakness [71.1%]. Absent or decreased deep tendon reflexes were seen in 44% and 53.3% patients, respectively. All children experienced some degree of pain, with moderate to severe intensity [pain faces score >/= 3] in 91.2% patients. Cranial nerve involvement was found in 46.7% children, most commonly as bulbar weakness [40%]. Ten [22.2%] patients were admitted in PICU, and ventilation support was needed for 2 [4.4%] of them. Clinical response was regain of unaided walking [ODS

Mass rearing of anopheles stephensi on human blood by artificial feeding under laboratory conditions

In order to control the diseases that are transmitted to human and animal by arthropod vectors, it is necessary to investigate vectors and to recognize control methods as well. These studies are applicable by rearing the colonies of arthropod blood-feeders like malaria and leishmaniasis in laboratory. The purpose of this study was to produce mass production of Anopheles stephensi [Lis.] by artificial feeding with human blood in insectary. We prepared an apparatus composed of a digital thermostat with sensor, element, contractor and magnet in order to blood-feed An. Stephensi. The Para film "M" and a human whole blood unit were used as a membrane and nutrient source for artificial feeding, respectively. The blood was placed in a soft lid and its surface was covered with Para film "M". The soft drink lids with blood were placed on the cage surface and indirectly warmed by element. An. Stephensi fed from blood. Three consecutive generations were reared without blood-feeding on host alike from the egg of mother colony. Female mosquito feeding rate was 47.7% to 64%. The average females feeding and ovipositing times were 10 and 9 times, respectively. No mortality was seen among the larvae. All of the pupae emerged to the adult. The second and third generation of population ratios to first population generation was 6 and 25 folds, respectively. Our findings showed that artificial feeding by human blood, especially in the investigational projects was completely efficient and suitable for increasing mosquitoes' population in specific time

Rapid elimination of German cockroach, Blatella germanica, by Fipronil and Imidacloprid gel baits

Baits have become popular and effective formulations against urban insect pests. Compared with residual sprays toxic gel baits are used more and more frequently to control urban cockroach populations. The aim of this study was to investigate the usage of two commercially available fipronil and imidacloprid gel bait formulations against Blattella germanica field infested in Iran. The study was carried out in an urban area at Tehran from March 2004 to September 2005. The 0.05% fipronil and 2.15% imidacloprid gel baits were placed continuously in 3 residential German cockroach infested units. Pre- and post-treatment cockroach density was assessed by visual count method. Pre- and post-treatment visual count of cockroaches in treatment and control areas, and percentage reduction in cockroach density in treatment areas in comparison to control areas was showed that density reduction was increased with the 0.05% fipronil and 2.15% imidacloprid gel baits in treated areas from 1st to 9th week in comparison to control area. After 60 days, German cockroaches eliminated completely from these areas. These results show that fipronil and imidacloprid gel baits are highly effective in field German cockroach infested after insecticide spraying control failure German cockroach infested fields where spraying of pyrethroid insecticides failed to control the situation and confirm previous reports stating that avermectin and hydramethylnon are more effective than conventional insecticides in baits against cockroaches. Therefore, fipronil and imidacloprid gel baits are appropriate candidates for controlling German cockroach infested dwellings in Iran where control with other insectices failed because of resistance

Rare variant of lycanthropy and ecstasy: case report

Lycanthropy is an unusual belief or delusion in which the patient thinks that he/she has been transformed into an animal. In rare cases, the patient believes that another person has been transformed into an animal. In this case report, a patient who had an uncommon variant of lycanthropy is introduced. The patient's symptoms had appeared after consumption of ecstasy. This shows the occurrence of uncommon and rare psychosis after ecstasy drug use especially in susceptible patients to schizophrenia. Ecstasy can induce paranoid psychosis similar to schizophrenia. It seems that in the presented case, ecstasy had a role in the incidence of the underlying suceptibility of the patient to schizophrenia

Use of a-interferon, amantadin and isoprinosine in subacute sclerosing panencephalitis [SSPE]: comparing the effectiveness

Sub acute Sclerosing Pan Encephalitis [SSPE], a progressive neurological disorder characterized by inflammation of the brain [encephalitis], is the result of an inappropriate immune response to the measles virus or measles vaccination. SSPE usually develops 2 to 10 years after the original viral attack. Some of the major signs and symptoms are mental deterioration, jerky movements, and seizures specially myoclonic type, involuntary movements, and/or behavioral changes, difficulty in walking, speech, and loss of cognition, respiratory distress and death. During the ten years, from July 1991 to July 2001, we admitted 45 cases of [SSPE], at different stages of the disorder. Regardless of their stage of disease, for intervention, randomly, we used one of three drugs; Amantadin, Interferon alfa and Isoprinosine, administered to the patients, for between one month to one year. Fourteen cases received Amantadin, 15 Alfa interferon, and 16 were given Isoprinosine. While the results show all three drugs to be relatively effective, Isoprinosine showed four times more effectiveness than Amantadin and twice as much as Interferon. The results showed Isoprinosine to be much more effective than Amantadin and Alfa interferon in treating the condition

[Once-daily therapy for streptococcal pharyngitis with amoxicillin vs, intramuscular benzathin penicillin G]

Recent studies have shown that amoxicillin, taken once a day may be as effective as oral penicillin V, three or four times a day, as an effective choice for treatment of group A beta-hemolytic streptococcal [GABHS] pharyngitis. The purpose of this study was to evaluate the effectiveness of once-daily amoxicillin vs intramuscular benzathine penicillin G in the treatment of streptococcal pharyngitis. Children 6-15 years of age presenting to a private pediatric clinic with GABHS pharyngitis in the urban population of Mashhad, Iran. Prospective randomized controlled study in which patients were randomly assigned to receive orally amoxicillin [750 mg once daily] for 10 days versus a single shot of intramuscular benzathin penicillin G [600.000-1.200.000IU]. They received orally amoxicillin by a health worker and compliance was monitored. After 48 hours if the first throat culture was positive, the patients were reevaluated by the same physician, and a second throat culture was obtained to evaluate bacteriologic response to treatment. Ninety-nine patients had throat swabs that yielded positive results on culture. In the latter group, 31 children were randomly assigned to receive intramuscularly penicillin, and 68 children were randomly assigned to receive once-daily amoxicillin. Outcomes were measured by impact on the clinical course and response, eradication of GABHS within 48 hours and compliance. Eleven of the amoxicillin-treated patients refused to take the drug, were noncompliant, or did not return for the follow-up visit. Three of this group, had residual positive culture 48 hours after treatment, and had bacteriologic failure with intramuscular penicillin. These were excluded as carriers, leaving 54 amoxicillin-treated patients. The children in the two treatment groups were comparable with respect to age and, gender. There were no significant differences in the clinical and bacteriological response, bacteriologic failure and residual positive cultures between the two groups after 48 hours. In the amoxicillin group, 18.9% failed to respond to treatment compared to 6.4% in the penicillin group. The difference was not statistically significant [P-value=0.1]. Our study was in line with two studies comparing oral forms of drugs. These data demonstrate that once-daily therapy with amoxicillin is as effective as intramuscular benzatine penicillin G for the treatment of GABHS pharyngitis

Duration of fipronil and imidacloprid gel baits toxicity against Blattella germanica strains of Iran

The current study was conducted to investigate the duration of fipronil and imidacloprid gel baits toxicity against German cockroach strains in Iran during 2003-2004. In order to conduct this study, nine German cockroach strains were used. Newly emerged adult male German cockroaches starved for one scotophase [12 h], and ingested fipronil and imidacloprid gel baits for 2 h. After the given time was over, the bait was removed and replaced with mouse pellet. Mortality was recorded at 12 intervals for 144 h [6 days]. Mortality data of the replicates were pooled and was tested using probit analysis. Both gel baits were toxic to adult male German cockroaches. In the ingested bait method, the susceptible strain showed LT[50] of 47.1 and 11.3 h for fipronil and imidacloprid gel baits, respectively, and the average LT[90] was 74.2 and 19.3 h, respectively. LT[50] of the feral German cockroach strains varied 14.9 h from 30.5 to 45.4 h and 4.4 h from 12.4 to 16.8 h for fipronil and imidacloprid gel baits, respectively. All German cockroach strains showed a similar susceptibility to fipronil and imidacloprid gel baits, compared with the susceptible laboratory strain. The steep slopes of ingested bait mortality curves indicated that the feral German cockroach strains were homogenous to fipronil and imidacloprid ingested gel baits. These results suggest that fipronil and imidacloprid gel baits appear to have considerable potential as a bait for insecticide-resistant strains of German cockroach

[Induced lactation in adopted mother]

It is a fact that most of physician dont beleive that only with stimulation of the breast and encouragement, in a woman is not pregnant and has not had delivery, adequate milk production [lactation] can be induced to feed an adopted child. In this case, we have induced lactation for a 30-years old lady who could never be pregnant as an adopted child. During 2 years fallow up, we have observed that babys growth curve was quite similar to normal pattern. In this period, baby was fed by his adopted mothers milk