VZV Encephalitis with Brucella coinfection-case report.

Encephalitis occasionally occurs due to the central nervous system (CNS) infection by Varicella-zoster virus (VZV). The coincidence of herpes Encephalitis-brain infection and brucellosis occurs rarely. In this case, a 56-year-old woman was described with low consciousness, seizures, fever, and mood disorders. The brain CT revealed no pathological lesions, but MR showed non-specific plaques in the periventricular white matter. VZV was detected in molecular tests for the panel of viral Encephalitis in cerebrospinal fluid (CSF). The blood culture and the Wright test revealed the presence of Brucella spp. The antiviral treatment of choice was Acyclovir, Levetiracetam to control seizures, and Ampicillin/Sulbactam as prophylaxis antibiotics. Coinfections common poor prognoses makes it crucial to administer antiviral medications immediately. Many clinical challenges require a multidisciplinary team, including involvement of the CNS, resistance to viral strains, reactivation of diseases, and drug toxicity. The early detection of Encephalitis and treatment can promptly prevent exacerbation and complications.

Efficacy of ozone therapy on visual evoked potentials in diabetic patients.

BACKGROUND: The involvement of the central nervous system is a frequent yet underestimated complication of diabetes mellitus. Visual evoked potentials (VEP) are a simple, sensitive, and noninvasive method for detecting early alterations in central optic pathways. The objective of this paralleled randomized controlled trial was to evaluate the impact of ozone therapy on visual pathways in diabetic patients. METHODS: Sixty patients with type 2 diabetes visiting clinics of Baqiyatallah university in Tehran (Iran) hospital were randomly assigned to two experimental groups: Group 1 (N = 30) undergoing a cycle of 20 sessions of systemic oxygen-ozone therapy in addition to standard therapy for metabolic control; Group 2 (N = 30)-serving as control-receiving only standard therapy against diabetes. The primary study endpoints were two VEP parameters; P100 wave latency and P100 amplitude at 3 months. Moreover, HbA1c levels were measured before the start of treatment and three months later as secondary study endpoint. RESULTS: All 60 patients completed the clinical trial. P100 latency significantly reduced at 3 months since baseline. No correlation was found between repeated measures of P100 wave latency and HbA1c (Pearson's r = 0.169, p = 0.291). There was no significant difference between baseline values and repeated measures of P100 wave amplitude over time in either group. No adverse effects were recorded. CONCLUSIONS: Ozone therapy improved the conduction of impulses in optic pathways of diabetic patients. The improved glycemic control following ozone therpay may not fully explain the reduction of P100 wave latency though; other mechanistic effects of ozone may be involved.

Neurological symptoms of COVID-19 infection; a cross-sectional study on hospitalized COVID-19 patients in Iran.

BACKGROUND: Coronavirus disease 2019 (COVID-19), a global issue now, can have a variety of clinical manifestations. Hundreds of articles have discussed different aspects of this infectious disease, such as physiopathology, epidemiology, clinical manifestations and treatment protocols. Recently, neurological manifestations of the disease have been found to be pretty common among COVID-19 patients. Here, neurological symptoms of COVID-19 infection with a focus on non-cerebrovascular complications are discussed in a large study population. METHODS: Neurological symptoms of 891hospitalized COVID-19 patients from March to June 2020 in a major Hospital, Tehran, Iran, were reviewed. Demographic characteristics and neurological manifestations were analyzed. RESULTS: Among 891 hospitalized COVID-19 patients, the following symptoms were observed: headache (63.9%), sleeping problems (51.3%), hyposmia/anosmia (46%), dizziness (45.4%), hypogeusia (42.1%), memory issues (31.5%), auditory disturbances (17.5%), paralysis (3.7%) and seizures (1.7%). In 29.7% of the patients, a neurological symptom was the initiating symptoms of the infection. Females were more likely to show headache and dizziness compared to males (p value<0.05). Headache intensity was also higher in females compared to males (p value<0.05). Headache prevalence was lower in older patients (p value<0.05), while memory loss and impaired consciousness were higher by increasing age (p values=0.002 and 0.001, respectively). CONCLUSION: Neurological manifestations were common among COVID-19 patients under study. Headache, as the most common neurological symptom among COVID-19 patients, was the most prevalent and intense among the female population. Headache, dizziness, sleeping problems, hyposmia/anosmia and hypogeusia were common COVID-19 neurological manifestations, while memory issues, auditory disturbances, paralysis, and seizures were less common.

Analysis of 239 ordinary and severe cases of COVID-19: Clinical features and treatment.

This study retrospectively analyzed the clinical characteristics of patients with new coronavirus infection (COVID-19) and summarizes the treatment experience. A total of 239 COVID-19 patients admitted to the Hajar Hospital, Aja University of Medical Science, Tehran, Iran from March 22, 2020 to May 18, 2020 were selected, including 176 cases in the ordinary group and 63 cases in the severe/critical group. We collected and compared the clinical data of the two groups of patients, including general conditions, clinical symptoms, signs, laboratory tests, lung CT imaging and prognosis, and analyzed the treatment plans of the two groups. The mean age of 239 COVID-19 patients was 48.1±17.6 years, including 132 males. Patients in the severe and critically ill groups were older than the normal group, with more males and more underlying diseases. The difference was statistically significant (p < 0.05). The lymphocyte (LYM) counts and albumin (ALB) counts of the severe and critically ill groups were more significantly lower than those of the normal group; while the percentage of neutrophils (NEU), C-reactive protein (CRP), D-dimer, and lactate The increase of lactate dehydrogenase (LDH) and urea nitrogen (BUN) was more significant, and the difference was statistically significant (p < 0.05). Patients in the severe and critically ill groups received more antiviral drugs, glucocorticoids, and nasal catheters than those in the normal group, and the difference was statistically significant (p < 0.05). Also, we observed that the most radiological finding was bilateral ground-glass opacity in both groups, however, the rate of typical abnormalities in both chest CT scan and chest x-ray was significantly higher in sever/critical group except air-bronchogram. Taken together, we showed that combination of oseltamivir and glucocorticosteroid such as dexamethasone was very effective in severe patients.

Guillain-Barré syndrome associated with COVID-19: a case report study.

Acute respiratory distress syndrome (ARDS) caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is spreading around the world. Patients with coronavirus disease 2019 (COVID-19) typically present fever, cough, and respiratory illnesses. It has been revealed that the comorbidities can turn it into severe types, and the managements meet unpredicted complications. Here, we report a case of coronavirus disease 2019 (COVID-19) coincidence with confirmed acute Guillain-Barré syndrome (GBS). Ten days after admission and therapeutic process, the patient developed autonomic dysfunction. Despite respiratory support and receiving intravenous immunoglobulin, the patient died due to cardiac arrest. Albeit it is yet scientifically doubtful, there are raising concerns toward a possible association between GBS and SARS-CoV-2 infection, demonstrating potential neurological symptoms of COVID-19.

A case report of simultaneous autoimmune and COVID-19 encephalitis.

COVID-19 encephalitis is a rare condition usually presenting with altered mental status. Simultaneous presence of anti-NMDAR antibody and SARS-CoV-2 virus in CSF is a very rare condition described in a few case reports so far. On the other hand, brain edema is an unusual presentation of anti-NMDAR encephalitis. Herein, we reported a case with simultaneous detection of anti-NMDAR antibody and SARS-CoV-2 virus in her cerebrospinal fluid (CSF) presenting with brain edema, altered mental status, seizures, and respiratory symptoms.

Central nervous system vasculopathy associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): a novel case report from Iran.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents respiratory symptoms as the most common clinical manifestations. Similar to some other viral infections, it can cause severe neurological damages. Here, we describe a 40-year-old man case who initially was admitted to a major hospital with presenting 7 days with weak flu-like symptoms (cough) and fever then presented neurology signs for 3 days. Physical examination and brain magnetic resonance imaging (MRI) showed cerebral vasculopathy. Molecular testing was performed on nasopharyngeal swab by real-time reverse transcription polymerase chain reaction (RT-PCR) which was positive for SARS-CoV-2. The patient received supportive cares and was treated with routine antiplatelet therapy. He was improved and discharged 10 days after admission with no symptoms. Our findings report a 40-year-old man with flu-like symptoms that indicate cerebral vasculopathy that was discharged with no symptoms. Therefore, physicians should be monitor patients with worsening or progressive central nervous system results. The pathobiology of this virus is still incompletely known; therefore, extensive studies are needed to reveal the effect of COVID-19 on the nervous system.

Cerium Oxide Nanoparticles (Nanoceria): Hopes in Soft Tissue Engineering.

Several biocompatible materials have been applied for managing soft tissue lesions; cerium oxide nanoparticles (CNPs, or nanoceria) are among the most promising candidates due to their outstanding properties, including antioxidant, anti-inflammatory, antibacterial, and angiogenic activities. Much attention should be paid to the physical properties of nanoceria, since most of its biological characteristics are directly determined by some of these relevant parameters, including the particle size and shape. Nanoceria, either in bare or functionalized forms, showed the excellent capability of accelerating the healing process of both acute and chronic wounds. The skin, heart, nervous system, and ophthalmic tissues are the main targets of nanoceria-based therapies, and the other soft tissues may also be evaluated in upcoming experimental studies. For the repair and regeneration of soft tissue damage and defects, nanoceria-incorporated film, hydrogel, and nanofibrous scaffolds have been proven to be highly suitable replacements with satisfactory outcomes. Still, some concerns have remained regarding the long-term effects of nanoceria administration for human tissues and organs, such as its clearance from the vital organs. Moreover, looking at the future, it seems necessary to design and develop three-dimensional (3D) printed scaffolds containing nanoceria for possible use in the concepts of personalized medicine.

Influence of Eimeria spp. infection and dietary inclusion of arginine on intestine histological parameters, serum amino acid profile and ileal amino acids digestibility in broiler chicks.

Coccidiosis is considered to be one of the most important challenge in the poultry industry causes economic losses due to the destruction in the digestive tract of chicken. It disturbs amino acids profile and their digestibility, leading to weight lost and economic burden. Using dietary arginine may decrease the adverse effects of coccidiosis on chicken digestive tract. This study aimed to evaluate the effects of dietary inclusion of arginine on intestine histological parameters, serum amino acid concentration and ileal amino acid digestibility of broiler chicks infected with coccidiosis. A total number of 384 one-d-old broiler chicks (Ross 308) of mixed sex with initial weight of 42 ±â€¯2 g was allocated into 8 groups with 8 birds/pen from grower period. At 21 days of age, broiler chicks were infected with a mixture of Eimeria spp. Broiler chicks were divided into infected and un-infected groups and received arginine at recommended levels of 85, 100, 125 and 150 %. Intestinal morphology and lesions, serum amino acid concentration and ileal amino acid digestibility were evaluated. Broiler chicks infected with Eimeria spp. showed lower villus height and villus height: crypt depth ratio and also higher intestinal lesions (P < 0.05). Coccidia infection decreased the ileal amino acid digestibility for all studied amino acids and also reduced serum concentrations of amino acids, except lysine and isoleucine (P < 0.05). Dietary supplementation of arginine especially in higher levels significantly increased villus height and villus height:crypt depth ratio and decreased lesions (P < 0.05). Moreover, dietary supplementing of arginine increased the serum concentration of arginine (P < 0.05), but it did not have any significant effect on its digestibility (P > 0.05). In sum, coccidiosis decreases amino acid digestibility and serum amino acid concentration, but dietary inclusion of higher levels of arginine significantly improved histological parameters of broiler chicks infected with coccidiosis.

Prediction of Serum Creatinine in Hemodialysis Patients Using a Kernel Approach for Longitudinal Data / 대한의료정보학회지

ObjectivesLongitudinal data are prevalent in clinical research; due to their correlated nature, special analysis must be used for this type of data. Creatinine is an important marker in predicting end-stage renal disease, and it is recorded longitudinally. This study compared the prediction performance of linear regression (LR), linear mixed-effects model (LMM), least-squares support vector regression (LS-SVR), and mixed-effects least-squares support vector regression (MLS-SVR) methods to predict serum creatinine as a longitudinal outcome.MethodsWe used a longitudinal dataset of hemodialysis patients in Hamadan city between 2013 and 2016. To evaluate the performance of the methods in serum creatinine prediction, the data was divided into two sets of training and testing samples. Then LR, LMM, LS-SVR, and MLS-SVR were fitted. The prediction performance was assessed and compared in terms of mean squared error (MSE), mean absolute error (MAE), mean absolute prediction error (MAPE), and determination coefficient (R2). Variable importance was calculated using the best model to select the most important predictors.ResultsThe MLS-SVR outperformed the other methods in terms of the least prediction error; MSE = 1.280, MAE = 0.833, and MAPE = 0.129 for the training set and MSE = 3.275, MAE = 1.319, and MAPE = 0.159 for the testing set. Also, the MLS-SVR had the highest R2, 0.805 and 0.654 for both the training and testing samples, respectively. Blood urea nitrogen was the most important factor in the prediction of creatinine.ConclusionsThe MLS-SVR achieved the best serum creatinine prediction performance in comparison to LR, LMM, and LS-SVR.

Evaluation of ganciclovir resistance in cytomegalovirus infection of renal transplant recipients in Tehran.

BACKGROUND: Human cytomegalovirus (CMV) infection is a major issue in solid organ transplant recipients. Although development of prophylaxis and preemptive procedures have presented significantly improved consequences in CMV infection, increasing incidence of antiviral resistance has raised virologists' concern. METHODS: The present study focused on kidney transplant recipients with high quantities of CMV load after antiviral therapy. We collected 5 mL blood from each of 58 patients. DNA extraction was performed with the use of the QIAamp DNA Mini kit (Qiagen), in accordance with the manufacturer's instructions. RESULTS: Our population study was 38% female and 62% male. CMV DNA was observed in 50 specimens (86%) with the range of 1.9 × 10(3) to 11 × 10(7) copies/mL serum. All of these patients had received ganciclovir for >3 months. Sequencing showed 18 mutations in 10 patients. Among these, 16 mutations were associated with Ul97 and the rest with Ul54 gene. Forty CMV-positive patients did not show any mutations. CONCLUSIONS: The consequences of long-term ganciclovir resistance could not be determined.

The effect of Persian shallot (Allium hirtifolium Boiss.) extract on blood sugar and serum levels of some hormones in diabetic rats.

Diabetes mellitus (DM) is caused by hyperglycemia, resulting from defective insulin secretion or function. It is widely believed that the antioxidant micronutrients obtained from plants afford significant protection against diseases like diabetes mellitus. Present study was aimed to examine the effects of Persian shallot (Allium hirtifolium Boiss) on FBS, HbA1c, insulin, triiodothyronine (T3) and thyroxine (T4) levels in type 1 diabetic rats. Thirty two male Wistar rats were divided into 4 groups of 8. The diabetic groups received 100 and 200 mg/kg Persian shallot extract, diabetic control and normal control received %0.9 saline for 30 days. At the end of treatments, fasting blood specimens were collected. The levels of FBS, HbA1c, insulin, T3 and T4 were measured. Our findings indicated that hydroalcoholic extract of Persian shallot significantly decreased serum levels of FBS and HbA1c in treated groups (in a dose dependent manner) (p<0.05). The serum levels of insulin and T3 slightly increased by Persian shallot but the T4 serum level was declined. These beneficial effects of Persian shallot extracts in diabetic rats could probably be due to the antioxidant capacity of its phenolic and diallyl disulfide content.

Hepatoprotective effects of hydroalcoholic extract of Allium hirtifolium (Persian shallot) in diabetic rats.

BACKGROUND: The prevalence of diabetes mellitus (DM) is dramatically increasing worldwide. Prospective studies have reported that high levels of hepatic enzymes, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), Alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) are associated with later development of diabetes. The aim of the present study was to examine the effect of hydroalcoholic extract of Allium hirtifolium (Persian shallot) on the level of liver enzymes in streptozotocin (STZ)-induced diabetic rats. METHODS: Thirty-two male rats were divided into four groups of eight. The diabetic groups received 100 and 300 mg/kg Persian shallot extract, the diabetic control and non-diabetic control groups received 0.9% saline for 30 days. At the end of the experimental period, fasting blood samples were collected, and enzymes levels were measured. RESULTS: Our findings showed that hydroalcoholic extract of Persian shallot can significantly decrease serum levels of liver enzymes (AST, ALT, ALP and LDH) in treated groups in a dose-dependent fashion (p<0.05). CONCLUSIONS: Antioxidant micronutrients in the extract of Persian shallot may rehabilitate liver damages caused by free radicals in diabetic rats.