Antibiotic use during the first 6 months of COVID-19 pandemic in Iran: A large-scale multi-centre study.

WHAT IS KNOWN AND OBJECTIVE: Although antibiotics are ineffective against viral infections, epidemiological studies have revealed that the COVID-19 pandemic resulted in the overuse of antibiotics and disruption of antimicrobial stewardship programmes. We investigated the pattern of antibiotic use during the first 6 months of the COVID-19 pandemic in Iran. METHODS: A multi-centre retrospective study was designed to investigate the use of 16 broad-spectrum antibiotics in 12 medical centres. The rate of antibiotic use was calculated and reported based on the Defined Daily Dose (DDD) per 100 hospital bed-days. The bacterial co-infection rate was also reported. RESULTS AND DISCUSSION: Totally, 43,791 hospitalized COVID-19 patients were recruited in this study. It was found that 121.6 DDD of antibiotics were used per 100 hospital bed-days, which estimated that each patient received approximately 1.21 DDDs of antibiotics every day. However, the bacterial co-infections were detected only in 14.4% of the cases. A direct correlation was observed between the rate of antibiotic use and mortality (r[142] = 0.237, p = 0.004). The rate of antibiotic consumption was not significantly different between the ICU and non-ICU settings (p = 0.15). WHAT IS NEW AND CONCLUSION: In this study, widespread antibiotic use was detected in the absence of the confirmed bacterial coinfection in COVID-19 patients. This over-consumption of broad-spectrum antibiotics may be associated with increased mortality in hospitalized COVID-19 patients, which can be an alarming finding.

Female genital tract tuberculosis presenting as ovarian cancer.

BACKGROUND: Tuberculosis (TB) is still a major worldwide concern. There is no pathognomonic clinical feature or imaging findings for definite diagnosis of extra pulmonary TB. Therefore, TB involvement of Gastrointestinal or Genitourinary tract can be easily confused with peritoneal carcinomatosis and advanced ovarian carcinoma. Our aim is to emphasize the importance of considering the disease based upon the epidemiologic clues of the patients, while interpreting the positive results for a suspicious ovarian malignancy. CASES: This paper illustrates 8 cases of ovarian or peritoneal tuberculosis, whose initial diagnoses were malignant processes of the GU tract. CONCLUSION: Tuberculosis (TB) should be always being considered in the differential diagnosis of advanced ovarian cancer, especially in the regions that are endemic for the disease.

A rare intraosseous synovial sarcoma of the mandible: A case report.

INTRODUCTION: Synovial sarcoma is a relatively common high-grade soft-tissue sarcoma. This lesion accounts for 5-10 % of soft-tissue sarcomas, which tend to appear in the limbs, especially the lower limbs. Synovial sarcoma in the neck is rare and causes involvement of the head and neck in 6-7 % of cases. Intraosseous involvement of the mandible is rare. In this report, a rare intraosseous synovial sarcoma of the mandible is reported. PRESENTATION OF CASE: A 29-year-old man with a complaint of painless outgrowth of the gingiva in the posterior region of the left mandible. In the intraoral examination, an exophytic, firm, smooth and well-defined lobulated mass on the alveolar ridge, extending from distal of the second premolar to mesial of the second molar, was observed. On a radiographic examination, a radiolucent lesion with an ill-defined border was seen in the left body of the mandibular with perforation of the buccal cortex. In a histological examination, immunohistochemistry confirmed synovial sarcoma. The patient underwent surgery with wide margins, and radiotherapy after surgery. DISCUSSION: The main treatment method is surgery with a wide margin. Radiotherapy as an adjuvant treatment along with surgery is the second most common treatment method. Radiotherapy is recommended in cases of involvement of the margin of the lesion, size greater than 5 cm, and recurrence of the lesion. Chemotherapy after surgery has been used less frequently. CONCLUSION: Surgical resection with a wide margin is the main treatment. Adjuvant radiation therapy and chemotherapy can be helpful in tumor control, especially in monophasic cases.

Recent Progress in the Application of Exosome Analysis in Ovarian Cancer Management.

Exosomes are very small (nano-sized) vesicles participating in tumor development by involvement in intercellular communication mediated by transferring biocomponents. Exosomes appear to play vital roles in various cancer development, such as ovarian cancer, a common malignancy in women. Several hallmarks of ovarian cancer are reported to be affected by the exosome-- mediated cellular cross-talk, including modulating peritoneal dissemination and chemoresistance. Since the expression of some biomolecules, such as miRNAs and mRNA, is changed in ovarian cancer, these exo-biomolecules can be applied as prognostic, diagnostic, and therapeutic biomarkers. Also, the selective loading of specific chemotherapeutic agents into exosomes highlights these biocarries as potential delivery devices. Exosomes could be artificially provided and engineered to better target the site of interest in ovarian cancer. In the present review, we summarize the notable achievement of exosome application in ovarian cancer management to gain applicable transitional insight against this cancer.

Malignant Peripheral Nerve Sheath Tumor, a rare Intraosseous Malignancy in the Mandible of a Patient with Neurofibromatosis Type 1: A Case Report.

Malignant peripheral nerve sheath tumor (MPNST) is a rare malignancy of nervous tissue. The oral incidence of this lesion is extremely low. MPNST can occur sporadically or in association with neurofibromatosis. We report a rare intraosseous MPNST in the mandible of a 33-year-old female patient with neurofibromatosis type 1.

Designing 3D Ternary Hybrid Composites Composed of Graphene, Biochar and Manganese Dioxide as High-Performance Supercapacitor Electrodes.

Biochar derived from waste biomass has proven to be an encouraging novel electrode material in supercapacitors. In this work, luffa sponge-derived activated carbon with a special structure is produced through carbonization and KOH activation. The reduced graphene oxide (rGO) and manganese dioxide (MnO2) are in-situ synthesized on luffa-activated carbon (LAC) to improve the supercapacitive behavior. The structure and morphology of LAC, LAC-rGO and LAC-rGO-MnO2 are characterized by the employment of X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD), BET analysis, Raman spectroscopy and scanning electron microscopy (SEM). The electrochemical performance of electrodes is performed in two and three-electrode systems. In the asymmetrical two-electrode system, the LAC-rGO-MnO2//Co3O4-rGO device shows high specific capacitance (SC), high-rate capability and excellent cycle reversibly in a wide potential window of 0-1.8 V. The maximum specific capacitance (SC) of the asymmetric device is 586 F g-1 at a scan rate of 2 mV s-1. More importantly, the LAC-rGO-MnO2//Co3O4-rGO device exhibits a specific energy of 31.4 W h kg-1 at a specific power of 400 W kg-1. Overall, the synergistic effect between the ternary structures of microporous LAC, rGO sheets and MnO2 nanoparticles leads to the introduction of high-performance hierarchical supercapacitor electrodes.

Breast cancer prediction using different machine learning methods applying multi factors.

OBJECTIVE: Breast cancer (BC) is a multifactorial disease and is one of the most common cancers globally. This study aimed to compare different machine learning (ML) techniques to develop a comprehensive breast cancer risk prediction model based on features of various factors. METHODS: The population sample contained 810 records (115 cancer patients and 695 healthy individuals). 45 attributes out of 85 were selected based on the opinion of experts. These selected attributes are in genetic, biochemical, biomarker, gender, demographic and pathological factors. 13 Machine learning models were trained with proposed attributes and coefficient of attributes and internal relationships were calculated. RESULT: Compared to other methods random forest (RF) has higher performance (accuracy 99.26%, precision 99%, and area under the curve (AUC) 99%). The results of assessing the impact and correlation of variables using the RF method based on PCA indicated that pathology, biomarker, biochemistry, gene, and demographic factors with a coefficient of 0.35, 0.23, 0.15, 0.14, and 0.13 respectively, affected the risk of BC (r2 = 0.54). CONCLUSION: Breast cancer has several risk factors. Medical experts use these risk factors for early diagnosis. Therefore, identifying related risk factors and their effect can increase the accuracy of diagnosis. Considering the broad features for predicting breast cancer leads to the development of a comprehensive prediction model. In this study, using RF technique a breast cancer prediction model with 99.3% accuracy was developed based on multifactorial features.

Down regulation of Cathepsin W is associated with poor prognosis in pancreatic cancer.

Pancreatic ductal adenocarcinoma (PDAC) is associated with a very poor prognosis. Therefore, there has been a focus on identifying new biomarkers for its early diagnosis and the prediction of patient survival. Genome-wide RNA and microRNA sequencing, bioinformatics and Machine Learning approaches to identify differentially expressed genes (DEGs), followed by validation in an additional cohort of PDAC patients has been undertaken. To identify DEGs, genome RNA sequencing and clinical data from pancreatic cancer patients were extracted from The Cancer Genome Atlas Database (TCGA). We used Kaplan-Meier analysis of survival curves was used to assess prognostic biomarkers. Ensemble learning, Random Forest (RF), Max Voting, Adaboost, Gradient boosting machines (GBM), and Extreme Gradient Boosting (XGB) techniques were used, and Gradient boosting machines (GBM) were selected with 100% accuracy for analysis. Moreover, protein-protein interaction (PPI), molecular pathways, concomitant expression of DEGs, and correlations between DEGs and clinical data were analyzed. We have evaluated candidate genes, miRNAs, and a combination of these obtained from machine learning algorithms and survival analysis. The results of Machine learning identified 23 genes with negative regulation, five genes with positive regulation, seven microRNAs with negative regulation, and 20 microRNAs with positive regulation in PDAC. Key genes BMF, FRMD4A, ADAP2, PPP1R17, and CACNG3 had the highest coefficient in the advanced stages of the disease. In addition, the survival analysis showed decreased expression of hsa.miR.642a, hsa.mir.363, CD22, BTNL9, and CTSW and overexpression of hsa.miR.153.1, hsa.miR.539, hsa.miR.412 reduced survival rate. CTSW was identified as a novel genetic marker and this was validated using RT-PCR. Machine learning algorithms may be used to Identify key dysregulated genes/miRNAs involved in the disease pathogenesis can be used to detect patients in earlier stages. Our data also demonstrated the prognostic and diagnostic value of CTSW in PDAC.

Passive smoking and nasopharyngeal colonization by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in daycare children.

Exposure to tobacco smoke may be associated with higher risk of nasopharyngeal colonization and infection by Streptococcus pneumoniae (SP), Haemophilus influenzae (HI), and Moraxella catarrhalis (MC). This study was done to determine the influence of passive smoking on S. pneumoniae, H. influenzae, and M. catarrhalis colonization rates among children. This is a prospective cross-sectional study. Tertiary referral centers with accredited otorhinolaryngology-head and neck surgery and Microbiology Departments. In this cross-sectional study, 2-6 years old children in 10 randomly selected day-care centers in northeast of Iran (Mashad) were studied. Smoking exposure and medical history were recorded. Carriage rates for aforementioned bacteria were analyzed on the basis of smoking exposure. 1,125 children (Female/Male: 597/528) with the mean age of 5.05 ± 0.98 years were studied. Carriage rates of S. pneumoniae, H. influenzae and M. catarrhalis among children were 10.1, 8.8 and 6.7%, respectively. Mixed colonization was found in 2.7%. There was a significant difference in carriage rates between children who live in smoking families compare to those with nonsmoking families for M. catarrhalis (P = 0.001) but not for S. pneumoniae, and H. influenza (P = 0.798 and P = 0.117, respectively). It seems exposure to tobacco smoke is associated with increased carriage rate of M. catarrhalis in day-care children.

Integrated hybrid architecture of metal and biochar for high performance asymmetric supercapacitors.

Two state-of-the-art electrodes were successfully synthesized and used to assemble both symmetric and asymmetric type supercapacitors. 3DFAB was fabricated by direct pyrolysis of green macroalgae in the presence of NaOH. Possible NaOH activation mechanisms are proposed, which explains the formation of oxygen functional groups through quick penetration of OH- and NaOH into the vacancies. To obtain CoTLM, the tile-like architecture of cobalt oxides was introduced to the 3D interconnected functional algal biochar (3DFAB) by a simple one-pot hydrothermal method under mild conditions. For the symmetric supercapacitors, the maximum specific capacitance of RAB, 3DFAB, and CoTLM were 158, 296, and 445 F g-1 at the current density of 1 A g-1. Regarding cobalt-based asymmetric systems, the maximum capacitance for the 3DFAB//CoTLM was 411 F g-1. This asymmetric supercapacitor device also retained 100.9% of its initial capacitance after 4000 cycles at the current density of 4 A g-1. Unbuffered aqueous electrolyte and the unique morphological structure used in this study might catapult forward commercialization of such advanced energy storage devices.

Concept based auto-assignment of healthcare questions to domain experts in online Q&A communities.

BACKGROUND: Healthcare consumers are increasingly turning to the online health Q&A communities to seek answers for their questions because current general search engines are unable to digest complex health-related questions. Q&A communities are platforms where users ask unstructured questions from different healthcare topics. OBJECTIVES: This study aimed to provide a concept-based approach to automatically assign health questions to the appropriate domain experts. METHODS: We developed three processes for (1) expert profiling, (2) question analysis and (3) similarity calculation and assignment. Semantic weight of concepts combined with TF-IDF weighting comprised vectors of concepts as expert profiles. Subsequently, the similarity between submitted questions and expert profiles was calculated to find a relevant expert. RESULTS: We randomly selected 345 questions posted by consumers for 38 experts in 13 health topics from NetWellness as input data. Our results showed the precision and recall of our proposed method for the studied topics were between 63 %-92 % and 61 %-100 %, respectively. The calculated F-measure in selected topics was between 62 % (Addiction and Substance Abuse) and 94 % (Eye and Vision Care) with a combined F-measure of 80 %. CONCLUSIONS: Concept-based methods using unified medical language system and natural language processing techniques could automatically assign actual health questions in different topics to the relevant domain experts with good performance metrics.

Similarity of medical concepts in question and answering of health communities.

The ability to automatically categorize submitted questions based on topics and suggest similar question and answer to the users reduces the number of redundant questions. Our objective was to compare intra-topic and inter-topic similarity between question and answers by using concept-based similarity computing analysis. We gathered existing question and answers from several popular online health communities. Then, Unified Medical Language System concepts related to selected questions and experts in different topics were extracted and weighted by term frequency -inverse document frequency values. Finally, the similarity between weighted vectors of Unified Medical Language System concepts was computed. Our result showed a considerable gap between intra-topic and inter-topic similarities in such a way that the average of intra-topic similarity (0.095, 0.192, and 0.110, respectively) was higher than the average of inter-topic similarity (0.012, 0.025, and 0.018, respectively) for questions of the top 3 popular online communities including NetWellness, WebMD, and Yahoo Answers. Similarity scores between the content of questions answered by experts in the same and different topics were calculated as 0.51 and 0.11, respectively. Concept-based similarity computing methods can be used in developing intelligent question and answering retrieval systems that contain auto recommendation functionality for similar questions and experts.

Europium oxide nanorod-reduced graphene oxide nanocomposites towards supercapacitors.

Fast charge/discharge cycles are necessary for supercapacitors applied in vehicles including, buses, cars and elevators. Nanocomposites of graphene oxide with lanthanide oxides show better supercapacitive performance in comparison to any of them alone. Herein, Eu2O3 nanorods (EuNRs) were prepared through the hydrothermal method and anchored onto the surface of reduced graphene oxide (RGO) by utilizing a sonochemical procedure (in an ultrasonic bath) through a self-assembly methodology. The morphologies of EuNRs and EuNR-RGO were characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD) and IR spectroscopy. Then, we used EuNRs and EuNR-RGO as electrode materials to investigate their supercapacitive behavior using cyclic voltammetry, galvanostatic charge-discharge, and electrochemical impedance spectroscopy techniques. In a 3.0 M KCl electrolyte and with a scan rate of 2 mV s-1, EuNR-RGO exhibited a specific capacity of 403 F g-1. Galvanostatic charge-discharge experiments demonstrated a specific capacity of 345.9 F g-1 at a current density of 2 A g-1. The synergy between RGO's flexibility and EuNR's high charge mobility caused these noticeable properties.

Sonochemical synthesis of terbium tungstate for developing high power supercapacitors with enhanced energy densities.

Sonochemically prepared nanoparticles of terbium tungstate (TWNPs) were evaluated through scanning electron microscopy (SEM), thermogravimetric analysis (TGA), X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FT-IR), UV-Vis spectroscopy, and the optimal products were further characterized in terms of their electrochemical properties using conventional and continuous cyclic voltammetry (CV, and CCV), galvanostatic charge/discharge technique, and electrochemical impedance spectroscopy (EIS). The CV studies indicated the TWNPs to have specific capacitance (SC) values of 336 and 205 F g-1 at 1 and 200 mV s-1, and galvanostatic charge-discharge tests revealed the SC of the TWNP-based electrodes to be 300 F g-1 at 1 Ag-1. Also continuous cyclic voltammetry evaluations proved the sample as having a capacitance retention value of 95.3% after applying 4000 potential cycles. In the light of the results TWNPs were concluded as favorable electrode materials for use in hybrid vehicle systems.

Technical Report on the Modification of 3-Dimensional Non-contact Human Body Laser Scanner for the Measurement of Anthropometric Dimensions: Verification of its Accuracy and Precision.

Introduction: Three-dimensional (3D) scanners are widely used in medicine. One of the applications of 3D scanners is the acquisition of anthropometric dimensions for ergonomics and the creation of an anthropometry data bank. The aim of this study was to evaluate the precision and accuracy of a modified 3D scanner fabricated in this study. Methods: In this work, a 3D scan of the human body was obtained using DAVID Laser Scanner software and its calibration background, a linear low-power laser, and one advanced webcam. After the 3D scans were imported to the Geomagic software, 10 anthropometric dimensions of 10 subjects were obtained. The measurements of the 3D scanner were compared to the measurements of the same dimensions by a direct anthropometric method. The precision and accuracy of the measurements of the 3D scanner were then evaluated. The obtained data were analyzed using an independent sample t test with the SPSS software. Results: The minimum and maximum measurement differences from three consecutive scans by the 3D scanner were 0.03 mm and 18 mm, respectively. The differences between the measurements by the direct anthropometry method and the 3D scanner were not statistically significant. Therefore, the accuracy of the 3D scanner is acceptable. Conclusion: Future studies will need to focus on the improvement of the scanning speed and the quality of the scanned image.

Detection of Coxiella burnetii in acute undifferentiated febrile illnesses (AUFIs) in Iran.

There are limited data on the aetiology of acute undifferentiated febrile illnesses (AUFIs) in Iran. Moreover, Coxiella burnetii has not previously been detected in clinical samples in this country. Previous studies have highlighted the importance of considering C. burnetii as a cause of AUFI. In this retrospective study, in 92 cases of AUFI where Q fever was suspected, C. burnetii DNA was detected in seven samples (7.36%). This is the first molecular confirmation of C. burnetii from clinical samples from Iran.

The Optimal Management of Acute Febrile Encephalopathy in the Aged Patient: A Systematic Review.

The elderly comprise less than 13 percent of world population. Nonetheless, they represent nearly half of all hospitalized adults. Acute change in mental status from baseline is commonly seen among the elderly even when the main process does not involve the central nervous system. The term "geriatric syndrome" is used to capture those clinical conditions in older people that do not fit into discrete disease categories, including delirium, falls, frailty, dizziness, syncope, and urinary incontinence. Despite the growing number of elderly population, especially those who require hospitalization and the high burden of common infections accompanied by encephalopathy among them, there are several unresolved questions regarding the optimal management they deserve. The questions posed in this systematic review concern the need to rule out CNS infection in all elderly patients presented with fever and altered mental status in the routine management of febrile encephalopathy. In doing so, we sought to identify all potentially relevant articles using searches of web-based databases with no language restriction. Finally, we reviewed 93 research articles that were relevant to each part of our study. No prospective study was found to address how should AFE in the aged be optimally managed.

A Healthy Young Woman with Acute Respiratory Distress Syndrome: an unfamiliar face of a familiar disease.

The presented case features a rare manifestation of pulmonary tuberculosis in a previously healthy young woman who had acute presentation of tuberculous pneumonia complicated by acute respiratory distress syndrome. In developing countries, mycobacterium tuberculosis is an important cause of community-acquired pneumonia (CAP). TB can present as an acute process and should be included in the differential diagnosis of CAP. This case is special in its manifestation from several clinical perspectives, including the lack of an underlying medical condition or immune defect and the development of acute respiratory distress syndrome (ARDS) in non-miliary and non-disseminated tuberculosis. In conclusion, the diagnosis of TB should be considered in all patients who present with CAP in endemic regions.

Idiopathic granulomatous mastitis: Long-discussed but yet-to-be-known.

Idiopathic granulomatous mastitis (IGM) is a chronic benign inflammatory disease of the breast with unknown etiology. It is an important diagnostic and therapeutic challenge, as most patients were initially misdiagnosed by their primary care physicians, leading to diagnostic confusion and heightened anxiety. Although several triggers have been proposed for development of IGM, the etiologic association of neither of them has been documented. Three main hypotheses about the possible causes of IGM have been suggested, including autoimmune response, infectious disease, and hormonal disruption. Here, we discuss a hypothetical perspective of IGM to explain the possible role of autoinflammation in the pathogenesis of the disease. We also reviewed the previously published literature on pathogenesis of IGM.

Sometimes There Is More Than One Puzzle on the Table: Pneumococcal Bacteremia as a New Systemic Lupus Erythematosus Presentation.

Infection is common and a leading cause of death in patients with systemic lupus erythematosus (SLE). SLE is associated with a diverse spectrum of immune impairments including humoral defects and hypocomplementemia that contribute to a lupus patient's increased susceptibility to infection with encapsulated bacteria. Nonetheless, there are only few reports of severe invasive bacterial infection as the initial presentation of SLE in the literature. Here, we report a rare case of SLE presenting with pneumococcal bacteremia. Based on the high resolution chest computed tomography and the result of blood cultures, the bacteremia was assumed to be secondary to pneumococcal pneumonia.