Nano fuzzy alarming system for blood transfusion requirement detection in cancer using deep learning.

Periodic blood transfusion is a need in cancer patients in which the disease process as well as the chemotherapy can disrupt the natural production of blood cells. However, there are concerns about blood transfusion side effects, the cost, and the availability of donated blood. Therefore, predicting the timely requirement for blood transfusion considering patient variability is a need, and here for the first-time deal with this issue in blood cancer using in vivo data. First, a data set of 98 samples of blood cancer patients including 61 features of demographic, clinical, and laboratory data are collected. After performing multivariate analysis and the approval of an expert, effective parameters are derived. Then using a deep recurrent neural network, a system is presented to predict a need for packed red blood cell transfusion. Here, we use a Long Short-Term Memory (LSTM) neural network for modeling and the cross-validation technique with 5 layers for validation of the model along with comparing the result with networking and non-networking machine learning algorithms including bidirectional LSTM, AdaBoost, bagging decision tree based, bagging KNeighbors, and Multi-Layer Perceptron (MLP). Results show the LSTM outperforms the other methods. Then, using the swarm of fuzzy bioinspired nanomachines and the most effective parameters of Hgb, PaO2, and pH, we propose a feasibility study on nano fuzzy alarming system (NFABT) for blood transfusion requirements. Alarming decisions using the Internet of Things (IoT) gateway are delivered to the physician for performing medical actions. Also, NFABT is considered a real-time non-invasive AI-based hemoglobin monitoring and alarming method. Results show the merits of the proposed method.

Evaluation of three common scoring systems in COVID-19 patients: neutrophil-lymphocyte ratio (NLR), The Acute Physiology and Chronic Health Evaluation II (APACHE II), and C-reactive protein (CRP).

Background: As SARS-CoV-2 becomes a major global health, the authors aimed to predict the severity of the disease, the length of hospitalization, and the death rate of COVID-19 patients based on The Acute Physiology and Chronic Health Evaluation II (APACHE II) criteria, neutrophil-lymphocyte ratio (NLR), and C-reactive protein (CRP) levels to prioritize, and use them for special care facilities. Methods: In a retrospective study, 369 patients with COVID-19 hospitalized in the ICU from March 2021 to April 2022, were evaluated. In addition to the APACHE II score, several of laboratory factors, such as CRP and NLR, were measured. Results: The values of CRP, NLR, and APACHE II scores were significantly higher in hospitalized and intubated patients, as well as those who died 1 month and 3 months after hospital discharge than those in surviving patients. The baseline NLR levels were the strongest factor that adversely affected death in the hospital, death 1 month and 3 months after discharge, and it was able to predict death, significantly. Conclusion: CRP, NLR, and APACHE II were all linked to prognostic factors in COVID-19 patients. NLR was a better predictor of disease severity, the need for intubation, and death than the other two scoring tools.

A rare case of carotid artery injury during maggot debridement therapy for locally advanced parotid gland carcinoma.

INTRODUCTION AND IMPORTANCE: Maggot debridement therapy (MDT) is a treatment for chronic ulcers that involves using live larvae to debride the wound. CASE PRESENTATION: We report a case of serious arterial bleeding in the cervical region in a 52-year-old woman who was hospitalized in Iran for a malignant ulcer of the retro-auricular area. The patient was brought to the hospital by Emergency medical service due to severe hemorrhagic shock. CLINICAL DISCUSSION: Debridement is a commonly used method for wound management, aimed at reducing the risk of infection and removing ulcer debridement. Several techniques are available for debridement of chronic wounds, including mechanical, surgical, autolytic, and enzymatic methods, each with its own advantages and disadvantages. CONCLUSION: Maggot debridement therapy (MDT) is one of these methods that seem to be relatively safer. In this method, some larvae are used for debriding wounds in patients. It is usually used as a last resort treatment but in this case, it was used as a third line after surgery and chemoradiotherapy.

Serum cystatin C and inflammatory factors related to COVID-19 consequences.

BACKGROUND: Besides impaired respiratory function and immune system, COVID-19 can affect renal function from elevated blood urea nitrogen (BUN) or serum creatinine (sCr) levels to acute kidney injury (AKI) and renal failure. This study aims to investigate the relationship between Cystatin C and other inflammatory factors with the consequences of COVID-19. METHODS: A total of 125 patients with confirmed Covid-19 pneumonia were recruited in this cross-sectional study from March 2021 to May 2022 at Firoozgar educational hospital in Tehran, Iran. Lymphopenia was an absolute lymphocyte count of less than 1.5 × 109/L. AKI was identified as elevated serum Cr concentration or reduced urine output. Pulmonary consequences were evaluated. Mortality was recorded in the hospital one and three months after discharge. The effect of baseline biochemical and inflammatory factors on odds of death was examined. SPSS, version 26, was used for all analyses. P-vale less than 0.05 was considered significant. RESULTS: The highest amount of co-morbidities was attributed to COPD (31%; n = 39), dyslipidemia and hypertension (27%; n = 34 for each) and diabetes (25%; n = 31). The mean baseline cystatin C level was 1.42 ± 0.93 mg/L, baseline creatinine was 1.38 ± 0.86 mg/L, and baseline NLR was 6.17 ± 4.50. Baseline cystatin C level had a direct and highly significant linear relationship with baseline creatinine level of patients (P < 0.001; r: 0.926). ). The average score of the severity of lung involvement was 31.42 ± 10.80. There is a direct and highly significant linear relationship between baseline cystatin C level and lung involvement severity score (r = 0.890, P < 0.001). Cystatin C has a higher diagnostic power in predicting the severity of lung involvement (B = 3.88 ± 1.74, p = 0.026). The mean baseline cystatin C level in patients with AKI was 2.41 ± 1.43 mg/L and significantly higher than patients without AKI (P > 0.001). 34.4% (n = 43) of patients expired in the hospital, and the mean baseline cystatin C level of this group of patients was 1.58 ± 0.90 mg/L which was significantly higher than other patients (1.35 ± 0.94 mg/L, P = 0.002). CONCLUSION: cystatin C and other inflammatory factors such as ferritin, LDH and CRP can help the physician predict the consequences of COVID-19. Timely diagnosis of these factors can help reduce the complications of COVID-19 and better treat this disease. More studies on the consequences of COVID-19 and knowing the related factors will help treat the disease as well as possible.

Manifestation of Ocular Myasthenia Gravis as an Initial Symptom of Coronavirus Disease 2019: A Case Report.

For a while, coronavirus disease-2019 (COVID-19) has been a major global pandemic. It primarily affects the respiratory system but has extrapulmonary manifestations such as gastrointestinal and neurological symptoms. Data on myasthenia gravis (MG), as a complication of COVID-19, are limited. We herein report the manifestation of ocular MG as an initial symptom of COVID-19. In November 2020, a 31-year-old healthy woman was referred to Firoozgar Hospital (Tehran, Iran) with left upper eyelid ptosis and diplopia as well as general weakness, myalgia, fever, and nasal congestion for four days prior to admission. Although the acetylcholine receptor antibody in her serum was negative, increased jitter in several muscles led to the diagnosis of ocular MG. Nasal swab reverse transcription-polymerase chain reaction (RT-PCR) assay tested positive for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Computed tomography (CT) scan of the chest revealed bilateral ground-glass opacities and some foci of consolidation formation, but the thymus was normal. The patient was successfully treated with remdesivir and dexamethasone. The patient was eventually discharged in good condition and with improved neurological symptoms. A limited number of studies have suggested a possible association between MG and COVID-19. Therefore, further data are required to substantiate the proposed association. Clinicians should be aware of ocular MG during the COVID-19 pandemic to better diagnose and manage patients with SARS-CoV-2 infection.

Potential role of gut microbiota in patients with COVID-19, its relationship with lung axis, central nervous system (CNS) axis, and improvement with probiotic therapy.

Coronavirus Disease 2019 (COVID-19) is a pandemic disease caused by a new corona virus. COVID-19 affects different people in different ways. COVID-19 could affect the gastrointestinal system via gut microbiota impairment. Gut microbiota could affect lung health through a relationship between gut and lung microbiota, which is named gut-lung axis. Gut microbiota impairment plays a role in pathogenesis of various pulmonary disease states, so GI diseases were found to be associated with respiratory diseases. Moreover, most infected people will develop mild to moderate gastrointestinal (GI) symptoms such as diarrhea, vomiting, and stomachache, which is caused by impairment in gut microbiota. Therefore, the current study aimed to review potential role of gut microbiota in patients with COVID-19, its relation with lung axis, Central Nervous System (CNS) axis and improvement with probiotic therapy. Also, this review can be a guide for potential role of gut microbiota in patients with COVID-19.

Prevalence of migraine in adults with celiac disease: A case control cross-sectional study.

AIM: Celiac disease (CD) is an immune-mediated disorder with various manifestations. The aim of this study was to evaluate the prevalence of gastrointestinal (GI) and extra-intestinal symptoms of celiac patients, especially migraine, and compare it with healthy individuals. METHODS: We compared 1000 celiac subjects (CS) registered at our celiac center with the control group for headache-based on International Classification of Headache Disorders, third edition criteria and their GI symptoms. Besides, CS with migraine and non-migrainous headache were compared in terms of GI symptoms and accompanied conditions. RESULTS: Headache was more common in CS than controls (34% vs 27% respectively, P value<0.001) and more prevalent in females (71.9% in females vs 28% in males, P value = 0.004). Moreover, the prevalence of migraine in CS was higher than controls (20.7 vs 11.9% respectively, P value<0.001). Furthermore, migraine was more prevalent in females with CD (80% in females vs 19% in males, P value = 0.033), and often without aura (76%). Abdominal pain (76.9%, P value = 0.025), diarrhea (54.9%, P value = 0.002), and constipation (42.9%, P value = 0.011) were the most common GI symptoms in CS with headache and more prevalent in CS with migraine. Conversely, type 1 diabetes mellitus was less common in CS with migraine than in CS with non-migrainous headache. (P value = 0.001). On multivariate logistic regression analysis, female sex (OR 1.50, 95%CI 1.22-1.83, P value < 0.001), and CD (OR 1.36, 95%CI 1.12-1.65, P value = 0.002) were independent predictors of headache, whereas age more than 60 years (OR 0.70, 95%CI 0.50-0.97, P value = 0.032) had a protective effect. CONCLUSION: Headache especially migraine is more prevalent in CS than healthy controls. In addition, abdominal pain, diarrhea, and constipation are more common in CS with migraine than in CS with non-migrainous headaches. Therefore, evaluation of CD in patients with migraine and these simultaneous GI symptoms seems reasonable.