Association of systemic complications with mortality in coronavirus disease of 2019: A cohort study on intensive care unit patients.

Background: Since the beginning of the coronavirus disease of 2019 (COVID-19) pandemic, concerns raised by the growing number of deaths worldwide. Acute respiratory distress syndrome (ARDS) and extrapulmonary complications can correlate with prognosis in COVID-19 patients. This study evaluated the association of systemic complications with mortality in severely affected COVID-19 patients. Materials and Methods: This retrospective study was done on 51 intensive care unit (ICU)-admitted COVID-19 adult patients who were admitted to the ICU ward of Khorshid hospital, affiliated with Isfahan University of Medical Sciences. Only the patients who had a definite hospitalization outcome (dead vs. survivors) were included in the study. Daily clinical and paraclinical records were used to diagnose in-hospital complications in these patients. Results: The sample was comprised of 37 males (72.5%) and 14 females (27.4%). The median age of patients was 63 years (Min: 20, Max: 84), with the mortality rate of 47.1%. In total, 70.6% of patients had at least one coexisting disorder. Chronic kidney disease was associated with the worse outcome (29.16% of dead patients against 3.70 of survived ones). Mechanical ventilation was used in 58.8% of patients. Patients who had received invasive ventilation were more likely to die (87.50% of dead patients against 7.40 of survivors), Complications including sepsis and secondary infections (odds ratio: 8.05, confidence interval: 2.11-30.63) was the strongest predictors of mortality. Conclusion: Complications including sepsis and secondary infections can increase the risk of death in ICU-admitted COVID-19 patients. Therefore, it is substantial that the physicians consider preventing or controlling these complications.

Whole-transcriptome sequencing-based concomitant detection of viral and human genetic determinants of cutaneous lesions.

Severe viral infections of the skin can occur in patients with inborn errors of immunity (IEI). We report an all-in-one whole-transcriptome sequencing-based method by RNA-Seq on a single skin biopsy for concomitantly identifying the cutaneous virome and the underlying IEI. Skin biopsies were obtained from healthy and lesional skin from patients with cutaneous infections suspected to be of viral origin. RNA-Seq was utilized as the first-tier strategy for unbiased human genome-wide rare variant detection. Reads unaligned to the human genome were utilized for the exploration of 926 viruses in a viral genome catalog. In 9 families studied, the patients carried pathogenic variants in 6 human IEI genes, including IL2RG, WAS, CIB1, STK4, GATA2, and DOCK8. Gene expression profiling also confirmed pathogenicity of the human variants and permitted genome-wide homozygosity mapping, which assisted in identification of candidate genes in consanguineous families. This automated, online, all-in-one computational pipeline, called VirPy, enables simultaneous detection of the viral triggers and the human genetic variants underlying skin lesions in patients with suspected IEI and viral dermatosis.

Effect of antioxidant therapy on the sperm DNA integrity improvement; a longitudinal cohort study.

BACKGROUND: The effect of antioxidant therapy on sperm DNA fragmentation index (DFI) and achieving natural pregnancy were under debate. Very few studies have showed the rate of pregnancy rate after the antioxidant therapy due to ethical and technical limitations. OBJECTIVE: The aim of this cohort study was to determine the improvement rate of sperm DFI and natural pregnancy rate after the antioxidant therapy in infertile men. MATERIALS AND METHODS: 1645 infertile men were subjected for this study from May 2015 to December 2017. The Spermogram and sperm DFI were assessed using World Health Organization (WHO) 2010-based protocols and sperm chromatin structure assay (SCSA), respectively, in sperm samples before and after antioxidant therapy. RESULTS: The total sperm DFI improvement rate was 38.9% in the total population. Sperm DFI improvement had close correlation with total motility (r= 0.731, p= 0.001) and progressive motility improvement (r= 0.885, p= 0.001); 16.8% of individuals who completed antioxidant therapy for nine months achieved natural pregnancy. CONCLUSION: The results of the current study suggested that SCSA along with spermogram might be a suitable option for the evaluation of fertility potential. In addition, antioxidant therapy may be useful for men with high levels of sperm DFI. However, the rate of pregnancy was still low and other treatment protocols such as assisted reproductive technology may be necessary.

SCSA results correlated with rate of motility reduction after ejaculation in Asthenozoospermia.

Maintaining sperm motility after ejaculation is important for fertilisation. Apoptosis may play an important role to reduce sperm motility after ejaculation. The aim of this study was to perceive whether or not an increase in apoptosis reduces sperm motility in a higher degree after ejaculation and whether it can be predicted by laboratory tests, such as sperm chromatin structure assay (SCSA). Fifty-one Asthenozoospermia and 20 fertile subjects participated in this study. SCSA was applied using flow cytometry. Fluorescein-labelled inhibitors of Caspases (FLICA) method was used for assessment of active Caspase-3. Motility was assessed every 2 hr after ejaculation for 12 hr. Both SCSA and spermatozoa with active Caspase-3 were significantly correlated with the rate of motility reduction after ejaculation. In the subgroups who had SCSA <27% and active Caspase-3 <40%, the sperm motility reduction significantly occurred 6-8 hr after ejaculation compared to the fresh sample. In the cases of SCSA ≥27% and active Caspase-3 ≥ 40%, a significant decrease in motility was observed between 2 and 4 hr after ejaculation. The result demonstrated a significant trend in the rate of sperm motility reduction with SCSA increase, which suggests SCSA may indirectly show a good scheme of apoptosis status and may forecast the rate of motility reduction after ejaculation in Asthenozoospermia.

Smoking motivators are different among cigarette and waterpipe smokers: The results of ITUPP.

The present study explores different drivers of cigarette and water pipe smoking among middle and high school students in Isfahan province. A questionnaire-based cross-sectional study was conducted. Trained staff collected questionnaires and saliva samples for response accuracy evaluation. Prevalence by demographic, parental and educational factors was calculated. Logistic regression was applied to compare behavior drivers of those who purely smoked cigarettes or a waterpipe. Waterpipe smokers were considered as the reference category. This study reported ORs along 95% confidence intervals; 5408 questionnaires were returned. The sample age was 15.37±01.70 on average. The self-reported prevalence of cigarette and waterpipe experimentation was 11.60% (n=624) and 20.70% (n=1,109), respectively; and 5.08% (n=311), 11.06% (n=619) for smokers, and 13.30% (n=711) for the whole sample. Psychological factors were the most important driver for cigarette smoking; bad event happening with odds of 2.38 (95% CI: 1.29-4.39); angriness 2.58 times (95% CI: 1.51-4.43); and distress by 2.49 times (95% CI: 1.42-4.40). Habitual situations were strong predictors of cigarette smoking, but not a predictor of waterpipe smoking, such as smoking after a meal (OR=3.11, 95% CI: 1.67-5.77); and smoking after waking up (OR=2.56, 95% CI: 1.42-4.40). Comprehensive and multifaceted preventive programs must tailor identified factors and increase family's awareness.

Experimental study of fs-laser induced sub-100-nm periodic surface structures on titanium.

In this work the formation of laser-induced periodic surface structures (LIPSS) on a titanium surface upon irradiation by linearly polarized femtosecond (fs) laser pulses with a repetition rate of 1 kHz in air environment was studied experimentally. In particular, the dependence of high-spatial-frequency-LIPSS (HSFL) characteristics on various laser parameters: fluence, pulse number, wavelength (800 nm and 400 nm), pulse duration (10 fs - 550 fs), and polarization was studied in detail. In comparison with low-spatial-frequency-LIPSS (LSFL), the HSFL emerge at a much lower fluence with orientation perpendicular to the ridges of the LSFL. It was observed that these two types of LIPSS demonstrate different fluence, shot number and wavelength dependencies, which suggest their origin is different. Therefore, the HSFL formation mechanism cannot be described by the widely accepted interference model developed for describing LSFL formation.

Widespread antibiotic resistance of diarrheagenic Escherichia coli and Shigella species.

BACKGROUND: Antibiotic resistance of enteric pathogens particularly Shigella species, is a critical world-wide problem and monitoring their resistant pattern is essential, because the choice of antibiotics is absolutely dependent on regional antibiotic susceptibility patterns. During summer 2013, an unusual increase in number of diarrheal diseases was noticed in Isfahan, a central province of Iran. Therefore, the antibiotic resistance of diarrheagenic Escherichia coli and Shigella species isolated were evaluated. MATERIALS AND METHODS: According to the guideline on National Surveillance System for Foodborn Diseases, random samples from patients with acute diarrhea were examined in local laboratories of health centers and samples suspicious of Shigella spp. were further assessed in referral laboratory. Isolated pathogens were identified by standard biochemical and serologic tests and antibiotic susceptibility testing was carried out by disc diffusion method. RESULTS: A total of 1086 specimens were obtained and 58 samples suspicious of Shigella were specifically evaluated. The most prevalent isolated pathogen was Shigella sonnei (26/58) followed by E. coli (25/58) and Shigella flexneri (3/58). A large number of isolated bacteria were resistant to co-trimoxazole (Shigella spp: 100%, E. coli: 80%), azithromycin (Shigella spp: 70.4%, E. coli: 44.0%), ceftriaxone (Shigella spp: 88.9%, E. coli: 56.0%) and cefixime (Shigella spp: 85.2%, E. coli: 68.0%). About88.3% of S. sonnei isolates, one S. flexneri isolate, and 56% of E. coli strains were resistant to at least three antibiotic classes (multidrug resistant). CONCLUSION: Due to high levels of resistance to recommended and commonly used antibiotics for diarrhea, continuous monitoring of antibiotic resistance seems essential for determining best options of empirical therapy.

Establishment of Health Clinics as Mass Screening and Referral Systems for Chronic Non-communicable Diseases in Primary Health Care.

BACKGROUND: This study aimed to establish a comprehensive screening and referral system for chronic non-communicable diseases (CNCD) in the routine primary health care, and to determine the prevalence of diabetes, pre-diabetes, metabolic syndrome, and dyslipidemia in adult population invited by public announcement to the Health clinics in Isfahan, Iran. METHODS: This survey was conducted from March 2010, and the current paper presents data obtained until November 2011. To provide health services for prevention and control of CNCDs, with priority of type2 diabetes mellitus, Health clinics were established in different parts of Isfahan city with a population of approximately 2,100,000 in Iran. The general populations aged 30 years and above were invited to the Health clinics by public announcement. RESULTS: A total of 198972 participants were screened. The mean age of participants was 47.8 years (48.5 men, 47.3 women), with a range of 1 to 95 years old and standard deviation of 12.3 years (12.7 men, 12.1 women). Overall, 22% of participants had impaired fasting glucose, 25% had hypercholesterolemia, 31% had hypertriglyceridemia, and 20% had metabolic syndrome. CONCLUSION: The high prevalence of dysglycemia and diabetes in our survey may serve as confirmatory evidence about the importance of mass screening and early diagnosis of CNCDs' risk factors. Our model of establishing Health clinics, as a comprehensive referral system in the routine primary health care can be adopted by Middle Eastern countries, where CNCDs notably diabetes are an emerging health problem.

Urine and milk iodine concentrations in healthy and congenitally hypothyroid neonates and their mothers.

INTRODUCTION: In view of the high prevalence of Congenital Hypothyroidism (CH) in Iran, in this study we evaluated the role of iodine in the aetiology of CH by comparing urine and milk iodine concentrations in healthy and congenitally hypothyroid neonates and their mothers. MATERIAL AND METHODS: In a cross-sectional study, urinary iodine concentrations (UIC) in newborns with CH, as well as UIC and the milk iodine concentrations (MIC) of their mothers, were measured and compared with a control group. The lower, mid, and upper range of UIC for neonates and lactating mothers was considered to be < 150 µg/L, 150-230 µg/L, and > 230 µg/L, and lower, mid, and upper range of MIC was considered to be < 150 µg/L, 150-180 µg/L, and > 180 µg/L, respectively. RESULTS: The median UICs in subjects with CH (n = 68) and healthy subjects (n = 179) were 300.5 and 290.5 µg/L, respectively (P > 0.05). The median UICs in the case and control groups were 150 and 130 µg/L, respectively (P > 0.05). The median MIC in the case group was higher than in the control group (210 µg/L v. 170 µg/L, P < 0.05).There was a positive correlation between newborn UIC and MIC. There was no significant correlation between newborn UIC and serum TSH, maternal UIC and maternal MIC, or newborn UIC and serum TSH. CONCLUSIONS: There is no inadequacy in iodine intake in the studied population. Iodine excess could be a possible risk factor for CH, but there were findings, such as lack of correlation between maternal MIC and UIC, and the median neonatal UIC, which was similar in the two groups, so, drawing conclusions should be done with some caution and requires further studies.

Thyroid function abnormalities among first-degree relatives of Iranian congenital hypothyroidism neonates.

BACKGROUND: Congenital hypothyroidism (CH) is a relatively common metabolic disease in neonates. Until recent years the disorder was usually regarded as occurring in a sporadic manner. Over the past few years, however, a considerable proportion of familial cases have been identified, and possible roles of autoimmune factors suggested. The aim of the present study was to evaluate abnormality of thyroid function tests in first-degree relatives of CH neonates and compared this to the normal population. METHODS: From 2002 until 2007 thyroid function tests (T4 and thyroid-stimulating hormone [TSH]) were done in randomly selected CH and normal neonates (n= 194 and n= 350, respectively) and their first-degree relatives. Most mothers of the CH neonates and control groups were also evaluated for thyroid peroxidase antibody (TPOAb). RESULTS: Thyroid function test in first-degree relative of neonates with CH (361 parents, 136 siblings) were compared with those in control groups (665 parents, 478 siblings). Abnormal thyroid function tests were found in 85 patients in the CH group versus 96 patients in the control group; hypothyroidism was found in 75 (15.1%) and 57 subjects (5%) person in the CH and control groups, respectively (P < 0.05). Positive TPO antibody was found in 22 mothers (17.3%) of CH neonates in comparison with 65 mothers (32.5%) of control groups (P < 0.05). Frequency of hyperthyroidism in parents of control group had trend to be higher than parents of CH neonates (P= 0.05) CONCLUSION: Familial and genetic components play a role in inheritance of CH, but maternal thyroid autoimmunity may not play an important role in the development of CH in Iran.