Analysis of Prevalence and Trends in the Biopsy-Proven Native Kidney Diseases in Iranian Population: A 12-year Survey from a Referral Center.

Background & Objective: The prevalence of glomerular diseases, as the leading cause of chronic kidney disease, is increasing. Renal biopsy is still the gold standard for diagnosis of the most kidney disorders. Data on prevalence of the biopsy-proven kidney diseases in Iran is limited and none of the previously reported studies used electron microscopic (EM) evaluation for the diagnosis. This study was conducted to analyze the prevalence of biopsy-proven kidney diseases in a referral center in Iran. Methods: The reports of kidney biopsy samples from 2006 to 2018 referred to a pathology center, affiliated with Tehran University of Medical Sciences were reviewed. The prevalence of different disorders was assessed based on the clinical presentation in 3 age categories, including childhood, adulthood, and elderly. Results: Among 3455 samples, 2975 were analyzed after excluding transplant-related specimens, suboptimal specimens, and those with uncertain diagnoses. Nephrotic syndrome (NS) (39%) was the most common cause of biopsy followed by subnephrotic proteinuria (18%), hematuria in association with proteinuria (15%), renal failure (9%), isolated hematuria (6%), lupus (4%) and the other non-specific manifestations such as hypertetion or malaise (each one less than 2%). The most common diagnoses included membranous nephropathy (MGN) (17.9%), focal segmental glomerulosclerosis (FSGS) (15.9%), lupus nephritis (LN) (13.7%), minimal histopathological findings (unsampled FSGS versus Minimal Change Disease, 12.1%), Immunoglobulin-A (IgA) nephropathy (6.5%) and Alport syndrome (6.1%). MGN was the most frequent disease before 2013, but FSGS became more frequent after that. Conclusion: NS and proteinuria were the most indications for kidney biopsy. Although MGN was the most common disease, the prevalence of FSGS has been increasing in recent years and making it the most common disease after 2013. LN and IgA nephropathy are the most common causes of secondary and primary GN presenting with proteinuria and hematuria, respectively.

Spectrum and Distribution of Biopsy-proven Kidney Diseases: A 12-year Survey of a Single Center in Iran.

Data about the prevalence of biopsy-proven kidney diseases in Iran are rare, and none of the previous studies used electron microscopy for diagnosis. This study aimed to analyze the prevalence of biopsy-proven kidney diseases in Iran's primary referral center. To the best of our knowledge, this is the most extensive study carried out in Iran. Reports of kidney biopsy samples from patients referred to our center in 2007-2018 were reviewed for demographic data, clinical presentation, and final diagnosis. Statistical analyses were performed. Among the 3455 samples received, 2975 were analyzed. Nephrotic syndrome (39%) was the most common cause of biopsy, followed by subnephrotic proteinuria (18%), hematuria in association with proteinuria (15%), renal failure (9%), isolated hematuria (6%), and lupus nephritis (LN) (4%). The most common diagnoses were membranous glomerulonephritis (17.9%), focal segmental glomerulosclerosis (FSGS) (15.9%), LN (13.7%), minimal histopathological findings (unsampled FSGS vs. minimal change disease, 12.1%), Immunoglobin A nephropathy (IgAN) (6.5%) and Alport syndrome (6.1%). NS and proteinuria were the most common indications for a kidney biopsy. IgAN and LN were the most common causes of primary and secondary glomerulonephritis, presenting with hematuria and proteinuria, respectively. Although membranous glomerulonephritis was the most common disease, it has been replaced by FSGS in recent years.

Evaluation of Early Repolarization Pattern in Children with Mitral Valve Prolapse.

BACKGROUND: Patients with mitral valve prolapse (MVP) may be prone to ventricular arrhythmias and sudden cardiac death and presence early repolarization pattern (ERP) in electrocardiography may be predict for ventricle arrhythmia. This study aimed to evaluation ERP in Children with MVP. METHODS: In a cross-sectional study, we enrolled ERP in 70 MVP children with 70 age-and sex-matched healthy individuals. After echocardiography procedure for confirmation MVP, standard 12-lead electrocardiography recordings with sweeping rate of 25mm/s and an amplitude of 10mV/cm, and two cardiologists assessed who were blinded to the both groups. RESULT: We detected ERP in 17.14% of MVP patient's and seen in 8 case (11.43%) in control group, (P=0.23). the ERP occurred in MVP patient's mild, moderate and severe 4, 6 and 2 cases, (P=0.29). The ERP found in patients with and without chest pain 13 and 7, respectively (P=0.46) and, in patients with and without palpitations 15 and 5 cases, respectively (P=0.24). The ERP occurred 1.6 time more in patient with MVP in comparing with individual without MVP. The ERP occurred more frequently in among patients with moderate MVP in comparing with severe and mild. Chest pain and palpitation occurred more frequently in among patients with severe MVP. CONCLUSION: The prevalence of ERP in children with MVP has been at a higher-level incidence, especially among patients with complaining from chest pain. We suggested that children with MVP are in need of follow up considering the occurrence of arrhythmias.

Detecting diseases in medical prescriptions using data mining methods.

Every year, the health of millions of people around the world is compromised by misdiagnosis, which sometimes could even lead to death. In addition, it entails huge financial costs for patients, insurance companies, and governments. Furthermore, many physicians' professional life is adversely affected by unintended errors in prescribing medication or misdiagnosing a disease. Our aim in this paper is to use data mining methods to find knowledge in a dataset of medical prescriptions that can be effective in improving the diagnostic process. In this study, using 4 single classification algorithms including decision tree, random forest, simple Bayes, and K-nearest neighbors, the disease and its category were predicted. Then, in order to improve the performance of these algorithms, we used an Ensemble Learning methodology to present our proposed model. In the final step, a number of experiments were performed to compare the performance of different data mining techniques. The final model proposed in this study has an accuracy and kappa score of 62.86% and 0.620 for disease prediction and 74.39% and 0.720 for prediction of the disease category, respectively, which has better performance than other studies in this field.In general, the results of this study can be used to help maintain the health of patients, and prevent the wastage of the financial resources of patients, insurance companies, and governments. In addition, it can aid physicians and help their careers by providing timely information on diagnostic errors. Finally, these results can be used as a basis for future research in this field.

Evaluating the Factors Affecting COVID-19 Patients' Mortality in Arak in 2020.

Background: The coronavirus disease 2019 (COVID-19) pandemic has been a leading cause of death in the world in the last few years. This study has investigated various causes and risk factors that may lead to death due to this disease. Methods: From June to October 2020, 98 expired and 196 recovered patients were studied for risk factors, underlying diseases, and laboratory findings that could lead to disease progression and mortality. Results: There was a significant relationship in terms of blood pressure, age, oxygen saturation, tachycardia, tachypnea, the interval between the onset of symptoms and hospitalization, diabetes mellitus, lung disease, cardiovascular disease, history of opium abuse, C-reactive protein, white blood cell, lymphocytes, hemoglobin, creatinine elevation, elevated liver enzyme, creatine phosphokinase, lactate dehydrogenase, ferritin, D-dimer, troponin, prothrombin time, international normalized ratio, intensive care unit admission days, arrhythmia, sepsis, acute respiratory distress syndrome, acute kidney injury (AKI), and the type of antiviral and antibiotic therapy between the two groups of patients. Conclusions: Mortality due to COVID-19 is affected by various causes such as age, underlying diseases, and complications that may occur in the course of the disease (e.g., arrhythmia, myocardial infarction, and AKI). By accurately identifying these causes and risk factors, we can prevent these complications and the mortality from COVID-19.

Simulating phosphorus leaching from two agricultural soils as affected by different rates of phosphorus application based on the geochemical model PHREEQC.

Phosphorus (P) leaching from agricultural soils, in consequence of long-term utilization of P fertilizers, decreases the water quality and leads to eutrophication. The effect of monopotassium phosphate (MKP) at the rates of 0, 50, 200, 400, and 800 mg P kg-1 on P and certain cations leaching from two agricultural soils (loam and sandy loam soils) was investigated in a laboratory study. Soil treatments were packed in columns with 5 cm in diameter, up to 10 cm. Soil columns were leached using distilled water solution for 20 pore volumes, and the leachates were analyzed for pH, electrical conductivity (EC), calcium (Ca), sodium (Na), potassium (K), and P. To simulate the concentrations of K and P in leachates, the PHREEQC model was utilized. In addition, the P vertical distribution in different depths of the soil columns after the leaching experiment was investigated using Olsen-extractable P (Olsen-P). Generally, as the MKP rates increased, the mean (mean of 20 pore volumes) value of pH and Ca concentration in leachates decreased, but the mean value of EC, Na, and K concentrations in leachates increased. In early pore volumes, the P concentration in all treatments begins to rise, then begins to fall. The application of different rates of MKP fertilizer increased the cumulative amount of P leached in both studied soils. Significant relations were obtained for the rates of MKP application and the cumulative amount of P leached. Overall, the model did a good job of simulating K and P concentrations in leachates, as well as the trend of K and P leaching. In both treated soils with increasing of fertilizer rates, the Olsen-P status in all depths increased, and the P content increased with depth. The Olsen-P contents before the leaching experiment for each treatment were predicted, and power equations significantly described its relation with mean P concentration in leachates. Higher application rates of MKP (400 and 800 mg P kg-1) resulted in much higher P concentrations in leachates than the threshold value (0.1 mg l-1), and these rates should not be used in agricultural soils, whereas applying 50 mg P kg-1 to agricultural soil could be a reasonable rate for preventing P losses.

Comparing Outcomes of Two Antiviral Therapy Combinations among COVID-19 Patients.

Several therapeutic regimens for COVID-19 have been studied, such as combination antiviral therapies. We aimed to compare outcome of two types of combination therapies atazanavir/ritonavir (ATV/r) or lopinavir/ritonavir (LPV/r) plus hydroxychloroquine among COVID-19 patients. 108 patients with moderate and severe forms of COVID-19 were divided into two groups (each group 54 patients). One group received ATV/r plus hydroxychloroquine, and the other group received hydroxychloroquine plus LPV/r. Then, both groups were evaluated and compared for clinical symptoms, recovery rates, and complications of treatment regimens. Our findings showed a significant increase in bilirubin in ATV/r-receiving group compared to LPV/r receivers. There was also a significant increase in arrhythmias in the LPV/r group compared to the ATV/r group during treatment. Other findings including length of hospital stay, outcome, and treatment complications were not statistically significant. There is no significant difference between protease inhibitor drugs including ATV/r and LPV/r in the treatment of COVID-19 regarding clinical outcomes. However, some side effects such as hyperbilirubinemia and arrhythmia were significantly different by application of atazanavir or lopinavir.

Frequency of Cardiovascular Complications and Its Association with Prognosis of COVID-19 Patients.

Coronavirus disease 2019 (COVID-19) may lead to acute respiratory disease; cardiovascular, gastrointestinal, and coagulation complications; and even death. One of the major complications is cardiovascular disorders, including arrhythmias, myocarditis, pericarditis, and acute coronary artery disease. The aim of this study was to evaluate the frequency of cardiovascular complications and to determine its association with the prognosis of COVID-19 patients. In a prospective analytic study, 137 hospitalized COVID-19 patients were enrolled. During hospitalization, an electrocardiogram (ECG) was performed every other day, and laboratory tests such as cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) were done 0, 6, and 12 hours after admission. These tests were repeated for patients with chest pain or ECG changes. Patients were categorized into three groups (improved, complicated, and expired patients) and assessed for the rate and type of arrhythmias, cardiac complications, lab tests, and outcomes of treatments. There was no significant relationship among the three groups related to primary arrhythmia and arrhythmias during treatment. The most common arrhythmia during hospitalization and after treatment was ST-T fragment changes. There was a significant age difference between the three groups (P = 0.001). There was a significant difference among the three groups for some underlying diseases, including diabetes mellitus (P = 0.003) and hyperlipidemia (P = 0.004). In our study, different types of arrhythmias had no association with patients' outcomes but age over 60 years, diabetes mellitus, and hyperlipidemia played an important role in the prognosis of COVID-19 cases.

Fabrication of flexible self-powered humidity sensor based on super-hydrophilic titanium oxide nanotube arrays.

Stable and flexible super-hydrophilic nanotubular-based titanium oxide electrode has been utilized as the active electrode of self-powered humidity sensor. TiO2 nanotubular electrodes fabricated through anodization method and utilized in combination with Kapton electrode as the triboelectric nanogenerator (TENG). Vertical contact-separation mode TENG performance has been examined in various range of frequencies and the maximum output voltage and current more than 300 V and 40 µA respectively with maximum power of 1.25 ± 0.67 mW has been achieved at 4 Hz. The fabricated TENG has been employed as the active self-powered humidity sensor. Super-hydrophilic feature of TiO2 nanotubes resulted in full absorption of water molecules, and noticeable decrease in charge transfer across two triboelectric materials upon increasing humidity. The TiO2-based TENG sensor was exposed to various relative humidity (RH) and the results showed that by increasing the humidity the output voltage and output current decreased from 162.24 ± 35.99 V and 20.4 ± 4.93 µA at RH = 20% to 37.92 ± 1.54 V at RH = 79% and 40.87 88 6.88 ± 1.7 µA at RH = 84%, respectively, Which shows the responsivity more than 300%. This method of measuring humidity has a simple and cost-effective fabrication that has various applications in many fields such as industry and medicine.

Reference Values of Longitudinal Systolic Right and Left Ventricular Function Measured by M-mode Echocardiography in Healthy Preterm and Term Neonates.

BACKGROUND: The mitral annular plane systolic excursion (MAPSE) and tricuspid annular plane systolic excursion (TAPSE) are parameters for evaluating systolic function, which is directly affected by ventricular morphology and geometry. MATERIALS AND METHODS: A cross-sectional study in term and preterm neonates calculated TAPSE and MAPSE at the lateral and septal (LAT/SEP) mitral. The study groups were divided into three classes based on birth age: two preterm groups, 30-33 weeks and 34-37 weeks, and one term group, 38-40 weeks. RESULTS: This study included 21 term neonates and 31 preterm neonates. The mean LAT MAPSE was 0.63 ± 0.11 cm for gestational age (GA) of 30-33 weeks, 0.76 ± 0.03 cm among GA of 34-36 weeks, and 0.84 ± 0.08 cm for GA of 37-40 weeks; the mean SEP MAPSE was 0.39 ± 0.14 cm, 0.51 ± 0.06 cm, and 0.65 ± 0.09 cm, respectively; and the mean TAPSE was 0.47 ± 0.13 cm, 0.62 ± 0.07 cm and 0.88 ± 0.15 cm, respectively. The mean LAT MAPSE was 0.63 ± 0.09 cm for neonates weighing 1500-2500 g and 0.82 ± 0.06 cm for those weighing 2500-3600 g; the mean SEP MAPSE was 0.39 ± 0.11 cm and 0.61 ± 0.09 cm, respectively. The LAT MAPSE showed a positive correlation with body surface area (BSA) and body weight (BW) (P = 0.0001). In addition, the SEP MAPSE indicated a positive correlation with BSA and BW (P = 0.0001). The TAPSE had a positive correlation with BSA (P = 0.0001) and BW (r = 0.876, P = 0.0001). CONCLUSIONS: The TAPSE and MAPSE values were calculated to establish the reference values for assessing global ventricular systolic function in neonate's health.

Successful Treatment of a Left Main Thrombus by Intracoronary Eptifibatide Infusion in a 36-Year-Old Patient.

The acute coronary syndrome due to the left main coronary artery (LMCA) thrombosis is a clinically rare and catastrophic event. We describe a young man (smoker, alcoholic, and drug abuser) with a history of recent surgery and typical chest pain who had non-occlusive LMCA thrombosis in coronary angiography. The thrombosis was successfully treated with two 180 µ/kg intracoronary boluses of eptifibatide, which was continued through an intravenous infusion at 2 µ/kg/min for 48 hours postprocedurally. Control angiography, performed 3 days later, revealed that the LMCA was free of thrombosis. The patient had no complaints, including chest pain, and remained completely asymptomatic during the next 30 days' follow-up.