Brain solutions for hearing problems during the COVID-19 pandemic and the misery of wearing a mask.

BACKGROUND: In COVID-19 pandemics days, wearing facial mask in public places has become obligatory to prevent the virus spread. In addition to its valuable protection, wearing facial mask can affect verbal communication in an adverse fashion and makes mutual understanding difficult. This happens because the mask eliminates the positive effect of the lip-reading phenomenon in direct communications. The mirror neuron system is responsible for automatic imitation, associative sequence learning, and motor mimicry. This system is a strong candidate justifying an unexpected action described in this article. PURPOSE: Taking the facial mask off, to help the listener understanding better is a normal reaction. However, unexpectedly, one does the same as the listener when he/she is unable to comprehend the speaker. Herein, we suggest a hypothesis proposing the basic role of Mirror neuron system in this action. Most of the research on these cells have been conducted on monkeys, where the researchers observed that, these neuron discharge pulses both when a monkey performs an action and when it observes another monkey or a person committing the similar action. CONCLUSION: The driving mechanism of an unanticipated action of taking off mask while listening to a speaker is emphasized in this paper. Herein, we try to clarify how we came up with the idea that mirror neuron system drives a surprising action observed in COVID-19 pandemics days. As a result, we suggest possible clinical studies to verify our hypothesis.

University of Wisconsin vs normal saline solutions for preservation of blood vessels of brain dead donors: A histopathological study.

OBJECTIVE: To compare the cellular changes of harvested arteries which were preserved in normal saline (NS) and the standard and routinely used University of Wisconsin (UW) solution. METHODS: This experimental study was conducted on 20 brain dead patients. The femoral and iliac arteries were bilaterally removed and were placed in NS and UW solutions. The vascular change indices including endothelial detachment (ED), medial detachment (MD), and internal elastic membrane disruption (IEMD) were surveyed for each preserver in the first, 5th, 10th, and 21st day. RESULTS: The mean age of the included patients was 32.28 ± 8.88 years, and there were 13 (65.0%) men and 7 (35.0%) women among the patients. The NS and UW preservation solutions were comparable regarding the indices of vascular changes at first, 5th, and 10th day of the study. Only in 21st day of the study, there was a significant difference between 2 group regarding MD changes (P = .049). CONCLUSION: The results of this in vitro study demonstrated that NS can be used as a worthy preserver for harvested vessels for up to 21 days, especially in resource-limited transplantation centers.

Mucoid impaction of the bronchi (MIB) in a young man with no previous history of hypersensitivity.

Mucoid impaction of the bronchi (MIB) is a specific form of proximal bronchiectasis characterized by obstruction and dilation of bronchi usually presented with thick mucoid plug. MIB mostly occurs as the manifestation of a hypersensitivity state in patients with bronchial asthma or in association with allergic bronchopulmonary aspergillosis (ABPA) and clinical overlap between MIB and ABPA can occur. MIB with no history of allergic background is not common and is less reported in the literature. In the following report we discuss a 39-year-old man with no previous history of allergy and atopy who initially presented with fever and shortness of breath. Further assessments demonstrated that the patient had a chronic endobronchial lesion and consolidation of the left lower lobe of the lung. A tissue biopsy reveals no malignant cells. Despite antibiotic therapy, the patient's symptoms persisted, and lobectomy was performed due to no clinical improvement. Even though gross pathology suggested endoluminal impaction, the patient didn't meet the ABPA diagnostic criteria.

Roles of Clinical Features and Chest CT in Predicting the Outcomes of Hospitalized Patients with COVID-19 Developing AKI.

This research aimed to evaluate the clinical features and computed tomography (CT) scans associated with poor outcomes in COVID-19 patients with acute kidney injury (AKI). A total of 351 COVID-19 patients (100 AKI, 251 non-AKI) hospitalized at Imam Hossein Teaching Hospital affiliated to Shahid Beheshti University of Medical Sciences were included. To investigate the factors associated with in-hospital mortality in COVID-19 patients developing AKI, COX univariate and multivariate regression models were applied after controlling other confounding variables. C-reactive protein CRP, lactate, and procalcitonin levels were significantly higher in AKI patients than in non-AKI patients (P < .05). In addition, AKI patients had higher frequencies of lymphopenia and leukocytosis (P < .05). The troponin levels and WBC were the most significant factors for predicting mortality in patients with AKI. Our findings showed that AKI per se is much more important than any other prognostic factor affecting non-AKI patients. However, AKI patients with higher CRP, PCT, and lactate levels had a poor prognosis.  DOI: 10.52547/ijkd.7241.

Validation of Effective Extracellular Vesicles Isolation Methods Adapted to Field Studies in Malaria Endemic Regions.

Malaria affects the poorer regions of the world and is of tremendous health and economic burden for developing countries. Extracellular vesicles (EVs) are small vesicles released by almost any cells in the human body, including malaria infected red blood cells. Recent evidence shows that EVs might contribute to the pathogenesis of malaria. In addition, EVs hold considerable value in biomarker discovery. However, there are still significant gaps in our understanding of EV biology. So far most of our knowledge about EVs in malaria comes from in vitro work. More field studies are required to gain insight into their contribution to the disease and pathogenesis under physiological conditions. However, to perform research on EVs in low-income regions might be challenging due to the lack of appropriate equipment to isolate EVs. Therefore, there is a need to develop and validate EV extraction protocols applicable to poorly equipped laboratories. We established and validated two protocols for EV isolation from cell culture supernatants, rodent and human plasma. We compared polyethylene glycol (PEG) and salting out (SA) with sodium acetate for precipitation of EVs. We then characterized the EVs by Transmission Electron Microscopy (TEM), Western Blot, Size-exclusion chromatography (SEC), bead-based flow cytometry and protein quantification. Both protocols resulted in efficient purification of EVs without the need of expensive material or ultracentrifugation. Furthermore, the procedure is easily scalable to work with large and small sample volumes. Here, we propose that both of our approaches can be used in resource limited countries, therefore further helping to close the gap in knowledge of EVs during malaria.

Primary Pleural Hemangioendothelioma: A Case Report and Literature Review.

Epithelioid hemangioendothelioma (EHE) is a rare tumor of the vascular endothelial cells. It can originate from any tissue; however, it occurs most frequently in the liver and lung. Pleural epithelioid hemangioendothelioma (PEH), EHE developing from pleura, is even more infrequent and less reported in the literature. In the following report, we discuss a 40-year-old man who initially presented with right-sided chest pain. Computed tomography revealed pleural thickening and effusion in his right thoracic cavity. PEH diagnosis was confirmed with immunohistochemistry. In order to provide the readers with an inclusive understanding of the disease, we collected the PEH cases reported in the literature. Despite the scarcity of the reported PEH cases (to our best knowledge), the compiled literature review of the disease enables the readers to grasp a better comprehension of the disease.

Clinical outcome of V-Y flap with latissimus dorsi and gluteal advancement for treatment of large thoracolumbar myelomeningocele defects: a comparative study.

OBJECTIVE: Surgical repair and closure of myelomeningocele (MMC) defects are important and vital, as the mortality rate is as high as 65%-70% in untreated patients. Closure of large MMC defects is challenging for pediatric neurosurgeons and plastic surgeons. The aim of the current study is to report the operative characteristics and outcome of a series of Iranian patients with large MMC defects utilizing the V-Y flap and with latissimus dorsi or gluteal muscle advancement. METHODS: This comparative study was conducted during a 4-year period from September 2013 to October 2017 in the pediatric neurosurgery department of Shiraz Namazi Hospital, Southern Iran. The authors included 24 patients with large MMC defects who underwent surgery utilizing the bilateral V-Y flap and latissimus dorsi and gluteal muscle advancement. They also retrospectively included 19 patients with similar age, sex, and defect size who underwent surgery using the primary or delayed closure techniques at their center. At least 2 years of follow-up was conducted. The frequency of leakage, necrosis, dehiscence, systemic infection (sepsis, pneumonia), need for ventriculoperitoneal shunt insertion, and mortality was compared between the 2 groups. RESULTS: The bilateral V-Y flap with muscle advancement was associated with a significantly longer operative duration (p < 0.001) than the primary closure group. Those undergoing bilateral V-Y flaps with muscle advancement had significantly lower rates of surgical site infection (p = 0.038), wound dehiscence (p = 0.013), and postoperative CSF leakage (p = 0.030) than those undergoing primary repair. The bilateral V-Y flap with muscle advancement was also associated with a lower mortality rate (p = 0.038; OR 5.09 [95% CI 1.12-23.1]) than primary closure. In patients undergoing bilateral V-Y flap and muscle advancement, a longer operative duration was significantly associated with mortality (p = 0.008). In addition, surgical site infection (p = 0.032), wound dehiscence (p = 0.011), and postoperative leakage (p = 0.011) were predictors of mortality. Neonatal sepsis (p = 0.002) and postoperative NEC (p = 0.011) were among other predictors of mortality in this group. CONCLUSIONS: The bilateral V-Y flap with latissimus dorsi or gluteal advancement is a safe and effective surgical approach for covering large MMC defects and is associated with lower rates of surgical site infection, dehiscence, CSF leakage, and mortality. Further studies are required to elucidate the long-term outcomes.

MicroRNA Expression Profiles, Target Genes, and Pathways in Intervertebral Disk Degeneration: A Meta-Analysis of 3 Microarray Studies.

BACKGROUND: Determining the expression profile and target genes of microRNA (miRNA) would assist in determining the pathophysiologic pathways in intervertebral disk degeneration (IDD). The aim of this study was to determine the expression profile of miRNA in degenerated intervertebral disks compared with normal healthy intervertebral disks. METHODS: We conducted a meta-analysis of 3 available miRNA expression datasets to identify a panel of co-deregulated miRNA genes and overlapping biological processes in IDD. Degenerated intervertebral disks were compared with normal healthy disks. We selected 35 miRNA features common to all 3 platforms. Then, we calculated differential expression P values from our unpaired data using metaMA package in R statistical software according to the moderated t test method (Limma). Based on the P values (where the threshold was <0.05), a list of differentially expressed miRNAs was identified. RESULTS: After normalization and selection of common miRNA features across all 3 platforms, we found a total of 5 differentially expressed miRNAs, among which miR-574-3p, miR-199a-5p, and miR-483-5p were not identified in any individual studies. Our results revealed that miR-199a-5p, miR-574-3p, miR-551a, and miR-640 are commonly upregulated in IDDs compared with control disks, whereas miR-483 is commonly downregulated. Pathway analysis of identified dysregulated miRNAs indicated the involvement of extracellular matrix-receptor interaction, adherens junction, and transforming growth factor-beta signaling pathway in the pathogenesis of IDDs. Moreover, the network of predicted targets for these miRNAs identified most affected target genes as ERBB4 and CLTC. CONCLUSIONS: We found that the identified miRNAs through meta-analysis are candidate predictive markers for IDDs through different pathways.

Acute Appendicitis during Pregnancy; Results of a Cohort Study in a Single Iranian Center.

OBJECTIVE: To determine the effects of pregnancy on the presentation, management, surgical and obstetrics outcome of patients with acute appendicitis. METHODS: This prospective cohort study was conducted during a 2-year period from 2014 to 2016 in Shahid Faghihi hospital of Shiraz University of Medical Sciences. We enrolled all the pregnant individuals with acute appendicitis who required surgical appendectomy. We also enrolled age-matched controls of non-pregnant women undergoing open appendectomy during the study period. The presentation, clinical and laboratory characteristics, surgical and obstetrics outcomes were determined in both study groups and were further compared between them. In order to determine the determinants of outcome, we also ran a multivariate logistic regression model. RESULTS: Overall we included a total number of 584 patients with presumed appendicitis among whom there were 58 (9.94%) and 526 (90.06%) non-pregnant individuals. The pregnant patients had significantly longer duration of symptoms (p=0.038), lower temperature (p=0.026), longer duration of hospital stay (p=0.026) and higher rate of hospital admission longer than 2 days (p=0.031). The complications of the surgical procedure were comparable between the two study groups except for the pneumonia which was significantly higher in pregnant patient (p=0.041). After adjusting for confounders such as age and ethnicity, pregnancy remained significantly associated with lower temperature (p=0.018), longer symptom duration (p=0.042) and higher rate of pneumonia (p=0.049). CONCLUSION: Acute appendicitis during the pregnancy was associated with longer duration of symptoms, lower body temperature and higher rate of pneumonia. The pregnancy and neonatal outcomes were comparable to the previously reported data.