Mucormycosis in patients with COVID-19: A cross-sectional descriptive multicentre study from Iran.

PURPOSE: The aim of the study was to report clinical features, contributing factors and outcome of patients with coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM). METHODS: A cross-sectional descriptive multicentre study was conducted on patients with biopsy-proven mucormycosis with RT-PCR-confirmed COVID-19 from April to September 2020. Demographics, the time interval between COVID-19 and mucormycosis, underlying systemic diseases, clinical features, course of disease and outcomes were collected and analysed. RESULTS: Fifteen patients with COVID-19 and rhino-orbital mucormycosis were observed. The median age of patients was 52 years (range 14-71), and 66% were male. The median interval time between COVID-19 disease and diagnosis of mucormycosis was seven (range: 1-37) days. Among all, 13 patients (86%) had diabetes mellitus, while 7 (46.6%) previously received intravenous corticosteroid therapy. Five patients (33%) underwent orbital exenteration, while seven (47%) patients died from mucormycosis. Six patients (40%) received combined antifungal therapy and none that received combined antifungal therapy died. CONCLUSION: Clinicians should be aware that mucormycosis may be complication of COVID-19 in high-risk patients. Poor control of diabetes mellitus is an important predisposing factor for CAM. Systematic surveillance for control of diabetes mellitus and educating physician about the early diagnosis of CAM are suggested.

Air pollution-related asthma profiles among children/adolescents: A multi-group latent class analysis.

BACKGROUND: This study aimed to investigate the asthma profile among children/adolescents and the relationship of the prevalence of air pollution profiles using latent class analysis (LCA). OBJECTIVES: In this cross-sectional study, a case rural community was selected in an industrial area, and two rural control communities were selected in unexposed areas. METHODS: Hourly concentrations of PM10, SO2, NO2, and total volatile organic compounds were obtained from the records of a fixed air quality monitoring station, and the concentrations of benzene, toluene, xylenes styrene were measured during six campaigns. Asthma data was collected using the International Study of Asthma and Allergies in Childhood in 7-18 years old children/adolescents. The modeling was conducted using LCA. RESULTS: A higher amount of air pollution indices were observed in the case than both control communities. LCA divided the participants into three clusters; "healthy" (92.8%), "moderate" (2.8%), and "severe" (4.4%). A higher probability of severe asthma (6.8%) was observed in the case than control communities (2.6% and 1.8%). Additionally, after adjusting for possible confounders, the odds of asthma was lower in the control communities than the case in both moderate and sever classes (Odds Ratios in the range of 0.135-0.697). CONCLUSIONS: This study indicates asthma profiles of children/adolescents and the higher prevalence of severe class in the area, explaining the possible effect of air pollution.

An empirical approach to the diagnosis and treatment of cerebrospinal fluid rhinorrhoea: an optimised method for developing countries.

BACKGROUND: We aimed to test a new approach for repairing cerebrospinal fluid (CSF) leaks and to determine the demographic, diagnostic, and treatment factors associated with the successful management of intracranial complication. Owing to the high frequency of endoscopic surgeries and the low cost of medical care in Iran, we decided to report our experience of reconstruction after CSF leaks. METHODS: We retrospectively reviewed our experience in the diagnosis and management of CSF rhinorrhoea in Iran between 2005 and 2012. The locations of all pre-repair leaks were identified using simple, readily available methods. The follow-up time ranged from 2 to 72 months. RESULTS: Of the 37 participants, 59.5% were men and the mean age was 33 years. The success rate was 86.1%, and the most common aetiological factor was trauma (57%). The most common location was the ethmoidal fovea (45.9%), followed by the sphenoid sinus (24.3%), the cribriform plate (13.5%), and the posterior table of the frontal sinus (5.4%). CONCLUSION: Medical care in Iran has considerable budget restrictions. This study advocates a practical method of treatment for patients in similar circumstances, with a success rate of 86.1% when compared to the 90.6% achieved with other techniques. KEYWORDS: cerebrospinal fluid leak, endoscopic, intracranial pressure ICP.

Predictive Value of Blood Markers in Nonfunctional Pituitary Adenomas using Artificial Neural Network.

Background: Nonfunctioning pituitary adenomas (NFPAs) are the most common pituitary tumors and although they do not secrete hormones, they can have systemic effects. These tumors affect the function of other organs in the body by exerting pressure on the pituitary gland. There are differences between biomarkers NFPAs compared to healthy people. This study was conducted to show blood marker changes in adenomas compared to healthy people. Materials and Methods: This article compared the blood markers of NFPAs with healthy individuals retrospectively. The difference between blood markers in the two groups was statistically investigated where the predictive value of blood markers in the differentiation of the two groups was determined. An artificial neural network was also designed using the blood markers with its accuracy and predictive value determined. Results: A total of 96 NFPAs (nonfunctional pituitary adenoma) and 96 healthy individuals were evaluated. There was statistically a significant difference and positive correlation in platelet to lymphocyte ratio, neutrophil to lymphocyte ratio, and derived neutrophil to lymphocyte ratio between NFPAs and healthy individuals. There was a significant and negative correlation between red blood cell (RBC), lymphocyte, and monocyte between the two groups. RBC as an independent factor was associated with NFPAs. In this study, the artificial neural network was able to differentiate between NFPTs cases and healthy individuals with an accuracy of 81.2%. Conclusion: There are differences between blood markers in NFPAs relative to healthy people and the artificial neural network can accurately differentiate between them.

Antrochoanal polyp: a comparative study of endoscopic endonasal surgery alone and endoscopic endonasal plus mini-Caldwell technique.

Antrochoanal polyp (ACP) originates in the maxillary sinus. To diminish the regrowth rate of choanal polyp, a complete removal of the antral portion and its attachment is necessary. There are several methods for this purpose, but in this study two techniques were comparatively investigated. This retrospective study was conducted by analyzing the database of 40 operated patients for ACP, 19 of whom underwent an endoscopic endonasal removal of polyps and 21 experienced endoscopic endonasal surgery with mini-Caldwell operation. The two techniques were compared with regard to their complications and regrowth rate. It emerged that post-operative complications (bleeding, synechia, ostia stenosis) in both groups were mild and there was not any significant difference between the two groups. Out of 19 cases in the endoscopic endonasal surgery group, 4 had recurrences, while in the mini-Caldwell group we had no recurrence. (P = 0.042)). This result implies that, in order to prevent incomplete excision and recurrences, combined approaches (endoscopic endonasal surgery and mini-Caldwell) should be considered, particularly when the attachment site of the antral part of ACP is undetected.

Thyroid Cancer Epidemiology in Iran: a Time Trend Study.

BACKGROUND: Considering the rising incidence of thyroid cancer worldwide, the aim of our study was to investigate the temporal trends in the incidence of this cancer in a large population of Iranian patients. MATERIALS AND METHODS: We used the Iran Cancer Data System (ICDS) Registry to assess the thyroid cancer trend from 2004 to 2010 with regard to different genders, age groups, and morphologies. To do this we analyzed the data of 10,913 new cases of thyroid cancer that occurred during these years. RESULTS: The incidence rate (per one year) of thyroid cancer was 2.20 per 100,000 persons between 2004 and 2010 in Iran. Papillary thyroid cancer was the most common histology type, with an annual rate of 0.29 in Iran. The highest rate of prevalence in thyroid cancer was observed at the age of 45 years at the time of diagnosis. We found a female-to-male ratio of 2 in Iran. A significant decrease was detected in the trend of thyroid cancer in children <19y, which was not correlated to the trend of older patients. CONCLUSIONS: As expected, the trend of thyroid cancer increased over the 7 years, primarily contributed by papillary thyroid cancer. A rising pattern of incidence was seen in all the age groups except patients aged under 19 years.

Recent Trends and Geographical Distribution of Thyroid Cancer in Iran from 2004 to 2009.

BACKGROUND: To prevent and control the cancers in Iran, the Iranian Department of Health has released the cancer rates data of the country. As the report has suggested, the incidence rate of thyroid cancer would be the most rapidly increasing among all the cancers. The study has aimed to carry out a qualitative assessment of thyroid cancer in Iran, during the 2004 to 2009, in a cross-sectional setting. METHODS: The incidence rates, the trend of individual provinces, the mean age at which the disease occurred, the correlation between incidence rate and median urinary iodine concentration were the parameters evaluated in our study. RESULTS: The average annual incidence rate during these six years was 2.17 per 100000. Chaharmahal-o-bakhtiari, had the highest incidence rate, but the East Azerbaijan provinces had the lowest incidence rates respectively. The age of diagnosis was the lowest in Ardebil but the highest in West Azerbaijan. In our study, we have found the positive correlation between thyroid cancer incidences with low urinary iodine concentration among all provinces (p-value=0.025). CONCLUSION: Presently, the only recognized measure procedure for reducing thyroid cancer risk would be perhaps the correction of median urinary iodine concentration. Further researches have seemed to be required for investigation the other factors, in order to introduce preventive measures in Iran.

Effectiveness of lumbar drain versus hyperventilation to facilitate transsphenoidal pituitary (suprasellar) adenoma resection.

BACKGROUND: Developing controlled hypercarbia is a known scheme of lowering the suprasellar part of the adenoma in order to assist the surgeon, which acts through raising the ICP and therefore the CSF pressure. OBJECTIVES: The purpose of this study is to compare the effect of introducing a lumbar drain with that of controlled hypercapnia on the quality of transsphenoidal pituitary tumor resection and CSF leak. PATIENTS AND METHODS: Fifty two patients with pituitary adenoma who underwent transsphenoidal hypophysectomy by the same surgeon were included. They were randomly divided into two groups. A lumbar drain catheter introduced into the L3-L4 subarachnoid space under local anesthesia in all patients. The same anesthesia was performed in both groups. In the study group, we used a saline injection into the subarachnoid space versus hypoventilation in the control group in order to increase the ICP according to the surgeon's request. The surgeon's satisfaction during the tumor resection and the resection time were assessed during the surgery. The CSF catheter was closed and sent with the patient for CSF drainage. If there was no CSF leak, the catheter removed 24 hours later. With evidence of a CSF leak, we used the catheter as a lumbar drain. The time taken for the leakage control was assessed. RESULTS: The satisfaction came from 21 (87.5%) and 2 (9.1%) for surgeon in the first and the second group respectively (P = 0.0001). CSF leakage time in the first and the second group was 1.6 ± 0.24 and 5 ± 0.50 respectively. It revealed a significant difference between the two groups (P = 0.001). The mean resection time was 13.54 ± 0.66 minutes in the study group; and 30.91 ± 0.98 minutes in the control group. CONCLUSIONS: In summary, the method described here for ICP manipulation is an effective procedure for a better visualization of the pituitary tumor during transphenoidal resection by surgeon and beneficial in managing the CSF leak following surgery.

Hearing status in neonatal hyperbilirubinemia by auditory brain stem evoked response and transient evoked otoacoustic emission.

Hyperbilirubinemia at neonatal period is one of the major deteriorating factors of the auditory system. If left untreated, it may cause certain cerebral damage. This study aims to evaluate the impact of hyperbilirubinemia on the hearing of neonate. This study was conducted on 35 newborn babies with jaundice (bilirubin more than 20 mg/dL). Auditory brainstem response (ABR) and transient evoked otoacoustic emission (TEOAE) tests were performed, after treatment and one year after. ABR test results indicated that 26 children (74.3%) had normal hearing but 9 (25.7%) suffered from an impairment. As for TEOAE test, 30 children (85.7%) passed whereas the remaining (14.3%) seemed to be failures. The comparative results of the two tests pointed to autonomic neuropathy /autonomic dysreflexia symptoms in 5 babies. Due to the high incidence of autonomic neuropathy/autonomic dysreflexia among hyperbilirubinemic babies, screening in this regard seems reasonable. Our result emphasizes the necessity of more experiments on the afflicted areas.

A comparative study of brain perfusion single-photon emission computed tomography and magnetic resonance imaging in patients with post-traumatic anosmia.

BACKGROUND: Loss of smell is a problem that can occur in up to 30% of patients with head trauma. The olfactory function investigation methods so far in use have mostly relied on subjective responses given by patients. Recently, some studies have used magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) to evaluate patients with post-traumatic anosmia. The present study seeks to detect post-traumatic anosmia and the areas in the brain that are related to olfactory impairment by using SPECT and MRI as imaging techniques. METHODS: The study was conducted on 21 patients suffering from head injury and consequently anosmia as defined by an olfactory identification test. Two control groups (traumatic normosmic and nontraumatic healthy individuals) were selected. Brain MRI, qualitative and semiquantitative SPECT with 99mtc-ethyl-cysteinate-dimer were taken from all the patients. Then the brain SPECT and MRI were compared with each other. RESULTS: Semi-quantitative assessment of the brain perfusion SPECT revealed frontal, left parietal, and left temporal hypoperfusion as compared with the two control groups. Eighty-five percent of the anosmic patients had abnormal brain MRI. Regarding the MRI, the main abnormality proved to be in the anterior inferior region of the frontal lobes and olfactory bulbs. CONCLUSIONS: The findings of this study suggest that damage to the frontal lobes and olfactory bulbs as shown in the brain MRI and hypoperfusion in the frontal, left parietal, and left temporal lobes in the semiquantitative SPECT corresponds to post-traumatic anosmia. Further neurophysiological and imaging studies are definitely needed to set the idea completely.