Parvimonas micra: A Rare Cause of Pleural Empyema With COVID-19 Co-infection.

Parvimonas micra, an oral anaerobe and a known gastrointestinal microbiota, has also been found to be enriched in mucosal tissues of the colon. Our patient presented with chest pain, productive cough, and hypoxia. He was diagnosed with COVID-19 pneumonia with a suspected superimposed bacterial infection. After the initiation of treatment, the patient developed a right hydropneumothorax/loculated pleural effusion on X-ray. Bedside drainage was done, and cross-sectional imaging showed findings of pleural empyema. Cultures obtained after bedside drainage grew P. micra. The patient underwent right posterolateral open thoracotomy, total lung decortication, wedge resection, pneumonolysis, and mechanical pleurodesis. Antimicrobial therapy was adjusted based on culture sensitivities and infectious disease evaluation. Adequate drainage and source control were achieved, COVID-19 infection was resolved, and the patient was discharged on oral antibiotics. This case report highlights a rare and interesting case of pleural empyema caused by a superimposed bacterial infection with P. micra in a patient with COVID-19 pneumonia.

Outcomes of surgical stabilization of rib fractures in a minority population: Retrospective analysis of a case series from an acute care facility.

Objective: The aim of was to examine the postoperative outcomes and associated factors of surgical stabilization of rib fracture (SSRF) in a minority population. Methods: A retrospective analysis with case series of 10 patients undergoing SSRF at an acute care facility in New York City was performed. Data, including patient demographic characteristics, comorbidities, hospital length of stay were collected. Results were presented in comparative tables and a Kaplan-Meier curve. Primary outcome was to compare outcomes of SSRF in minority patients to larger studies in nonminority populations. Secondary outcomes included various postoperative outcomes, including atelectasis, pain, and infection, and the influence of medical comorbidities on each. Results: The median time (with accompanying interquartile range) from diagnosis to SSRF, SSRF to discharge, and overall length of stay was 4.5 days (4.25), 6.0 days (17.00) and 10.5 days (18.25) days, respectively. The time until SSRF and postoperative complication rate were found to be comparable to those in larger studies. The Kaplan-Meier curve demonstrates a correlation between persistence of atelectasis to increased length of stay (P = .05). Increased time to SSRF was seen in elderly patients and patients with diabetes (P = .012 and P = .019, respecively). Increased pain requirements by patients with diabetes (P = .007), and higher infectious complications in patients with flail chest and diabetes (P = .035 and P = .002, respectively) were also seen. Conclusions: Preliminary outcomes and complication rates of SSRF in a minority population are shown to be comparable to larger studies in nonminority populations. Larger, higher-powered studies are required to further compare outcomes between these 2 populations.

Methicillin-Resistant Staphylococcus aureus (MRSA) Empyema Post-COVID Infection Causing Severe Septic Shock and Multiorgan Failure.

Secondary bacterial infections post-COVID infection posed a major challenge to the healthcare settings during the COVID pandemic. We present the case of an 81-year-old patient who was initially admitted for COVID pneumonia in a tertiary care hospital and was managed with a course of dexamethasone and had a good outcome. However, post-discharge, the patient developed symptoms of productive cough, hemoptysis and shortness of breath. Evaluation of the patient revealed that the patient had developed a secondary bacterial infection with Methicillin-resistant Staphylococcus aureus (MRSA), resulting in MRSA pneumonia and empyema. The patient was started on appropriate antibiotics and underwent thoracocentesis followed by video-assisted thoracoscopic surgery (VATS) and decortication. MRSA infection resulted in severe septic shock, acute respiratory distress syndrome (ARDS) and multiorgan failure. Successful intensive care unit (ICU) management of the life-threatening complications resulted in the remarkable recovery of the patient.

The effect of an infection control guideline on the incidence of ventilator-associated pneumonia in patients admitted to the intensive care units.

BACKGROUND AND AIM: Standard airway care can reduce the incidence of ventilator-associated pneumonia (VAP). This study aimed to determine the effect of implementing infection control guidelines on the incidence of VAP in patients admitted to the intensive care unit (ICU). MATERIALS AND METHODS: In this clinical trial, 121 patients admitted to the intensive care units of Golestan and Imam Khomeini hospitals of Ahvaz, Iran who were under mechanical ventilation were assigned to two groups of control and intervention in non-randomly allocation. The study was conducted in two consecutive periods. In the intervention group, infection control guidelines were performed to prevent VAP and in the control group, routine care was performed. Data collection is done by used a three-part instrument. The first part included questions on the patients' demographics and clinical information. The second part was the modified clinical pulmonary infection scale (MCPIS) for the early detection of VAP. The third part of the data collection instrument was a developed checklist through literature review. The MCPIS was completed for all patients on admission and the 5th day of the study. RESULTS: The two groups were homogenous respecting their baseline characteristics (P > 0.05) including the mean MCPIS score (P > 0.05). However, the intervention group had lower body temperature (P < 0.001), lower white blood cell counts (P < 0.038), lower MCPIS score (P < 0.001), and higher PaO2/FIO2 (P < 0.013) at the end of the study. The incidence of VAP was significantly lower in the intervention group when compared to the control group (i.e. 30% vs. 65.6%, P < 0.001). CONCLUSIONS: The implementation of infection control guidelines could significantly reduce the incidence of VAP and its diagnostic indicators in patients admitted to the ICU. Nurses are advised to use these guidelines to prevent VAP in patients admitted to ICU.

Impact of online social capital on academic performance: exploring the mediating role of online knowledge sharing.

Given the importance of digital communication during the COVID-19 pandemic, the need for advancing academic goals through online social capital is more tangibly felt. This study examined the hypothesis that online social capital can improve the students' academic performance, as one of the main academic goals, through the mediation of knowledge sharing in the online environment. Participants in the study were 376 graduate engineering students from five universities in Iran. The findings indicated that the bridging of online social capital had a positive and significant effect on the cognitive and social integrative benefits of online knowledge sharing. Besides, the social integrative benefits and personal integrative benefits of online knowledge sharing influenced academic performance. Finally, the social integrative benefits and personal integrative benefits had a mediating role in the relationship between the bridging of online social capital and academic performance. Implications of the findings are discussed for the students' academic performance and suggestions are provided for future research.

Waist Training Corset: An Unusual Cause of Acute Lower Limb Ischemia.

Acute limb ischemia (ALI) can occur due to many causes. This article illustrates a novel case of a very rare presentation and etiology of acute lower extremity ischemia. This case involves a middle-aged female with a history of smoking and obesity who presented with right lower extremity (RLE) pain. The patient had undergone a liposuction procedure a few days prior to her presentation and had been wearing a waist training corset. The patient was found to have multivessel thrombotic occlusive plaques starting from the right common iliac to the right tibial arteries. She was fully worked up and no other etiologies of her presentation was found. Thus, we concluded that her presentation was very likely precipitated by wearing the training corset, leading to right iliac artery thrombosis or perhaps a formal iliac atherosclerotic plaque destabilization and ipsilateral limb showering with athero-thrombi.

A noninterventional study evaluating the effectiveness of rotigotine and levodopa combination therapy in younger versus older patients with Parkinson's disease.

BACKGROUND: PD0013 was a 6-month noninterventional study in clinical practice comparing effectiveness/tolerability of rotigotine+levodopa in younger (<70 years) vs. older (≥70 years) Parkinson's disease (PD) patients. METHODS: Patients previously received levodopa for ≥6 months as monotherapy/in combination with another dopamine-agonist (DA). Primary variable: Unified PD Rating Scale (UPDRS) Part-II change from baseline to end-of-observation-period (EOP). RESULTS: 91 younger/99 older patients started rotigotine; 68 younger/62 older patients completed the study. Most switched from levodopa+another DA. Addition of rotigotine as first DA was more common in older patients (20.2% vs.15.4%). Mean ± SD rotigotine-exposure: 6.1 ± 3.4 mg/24h younger vs. 4.9 ± 2.4 mg/24h older. Eleven patients changed levodopa dose. At EOP, improvement in mean UPDRS-II was greater in younger patients (p = 0.0289). UPDRS-II responder-rate (≥20% decrease in UPDRS-II score) was higher in younger patients (42.3% vs. 25.9%). Improvement across age groups was similar on PD Sleep Scale-2 and Clinical Global Impressions-Improvement Scale. Adverse drug reactions (ADRs), and discontinuations because of ADRs, were more common among older patients. There were no new safety signals. CONCLUSIONS: Despite low rotigotine doses, when added to levodopa/switched from levodopa+another DA, rotigotine led to greater improvement in UPDRS-II in younger patients (<70 years). Individual patient data revealed clinically meaningful improvements in UPDRS-II in both groups.

Tracheostomy Exchange Resulting in Rare Combination of Pneumomediastinum, Pneumothorax, Massive Pneumoperitoneum, and Subcutaneous Emphysema.

Tracheostomy tube change is a relatively common and simple procedure once a tract is formed between the skin and the trachea. Regular tracheostomy tube changes decrease the risk of postoperative pulmonary infection and granulation tissue formation. However, serious complications, such as loss of airway, subcutaneous emphysema, and mediastinitis, can occur if the tube exchange is performed inappropriately. We present a rare association of subcutaneous emphysema, tension pneumothorax, pneumomediastinum, and pneumoperitoneum following a tracheostomy tube exchange in a 56-year-old patient who had his tracheotomy placed a month ago. The patient was successfully managed conservatively by chest tube and supportive care.

In vitro differentiation of neural stem cells derived from human olfactory bulb into dopaminergic-like neurons.

This study describes a new accessible source of neuronal stem cells that can be used in Parkinson's disease cell transplant. The human olfactory bulb contains neural stem cells (NSCs) that are responsible for neurogenesis in the brain and the replacement of damaged cellular components throughout life. NSCs are capable of differentiating into neuronal and glial cells. We isolated NSCs from the olfactory bulb of brain-death donors and differentiated them into dopaminergic neurons. The olfactory bulb tissues obtained were cultured in Dulbecco's modified Eagle's medium/nutrient mixture F12, B27 supplemented with basic fibroblast growth factor, epidermal growth factor and leukemia inhibitory factor. The NSCs and proliferation markers were assessed. The multipotentiality of olfactory bulb NSCs was demonstrated by their capacity to differentiate into neurons, oligodendrocytes and astrocytes. To generate dopaminergic neurons, olfactory bulb NSCs were differentiated in neurobasal medium, supplemented with B27, and treated with sonic hedgehog, fibroblast growth factor 8 and glial cell-derived neurotrophic factor from the 7th to the 21st day, followed by detection of dopaminergic neuronal markers including tyrosine hydroxylase and aromatic l-amino acid decarboxylase. The cells were expanded, established in continuous cell lines and differentiated into the two classical neuronal phenotypes. The percentage of co-positive cells (microtubule-associated protein 2 and tyrosine hydroxylase; aromatic l-amino acid decarboxylase and tyrosine hydroxylase) in the treated cells was significantly higher than in the untreated cells. These results illustrate the existence of multipotent NSCs in the adult human olfactory bulb that are capable of differentiating toward putative dopaminergic neurons in the presence of trophic factors. Taken together, our data encourage further investigations of the possible use of olfactory bulb NSCs as a promising cell-based therapeutic strategy for Parkinson's disease.

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.

Surgical resection of a giant primary liposarcoma of the anterior mediastinum.

This case describes the incidental finding and surgical removal of an 1.8-kg liposarcoma in the anterior mediastinum. These tumors are very rare and would normally present with symptoms of intrathoracic compression; however, this patient was completely asymptomatic. The case presentation and treatment rationale are described along with a brief review of existing literature.

Epidemiology of Nasopharyngeal Cancers in Iran: A 6-year Report.

BACKGROUND: Nasopharyngeal cancer is a disease with distinct ethnic and geographical distribution. The aim of this review was to describe the epidemiological characteristics of nasopharyngeal cancer in Iran from 2004 to 2009 because no systematic study has been performed to evaluate the trends of its incidence yet. MATERIALS AND METHODS: The data were derived from the databases of the National Cancer Data System Registry in the period of 2004-2009. Nasopharyngeal cancers were classified according to the International Classification of Diseases for Oncology. Incidence rates and trends were calculated and evaluated by gender, age decade, and histopathology types. RESULTS: A total of 1,637 nasopharyngeal cancers were registered in Iran from 2004 to 2009 giving an incidence of 0.38 per 100,000. The male-to-female ratio was 2.08:1. The trend of incidence was found to have increased, with a significant increase observed in males. Undifferentiated carcinoma was the most common histopathology type in all the age decades. CONCLUSIONS: Because the incidence of nasopharyngeal cancers in Iran has increased, especially in males, further studies are recommended for understanding of the etiological factors involved in the rise of the disease.

Evaluation of costs of epilepsy using an electronic practice management software in Germany.

PURPOSE: This study used an electronic practice management software in daily routine to gather long-term disease and cost-of-illness (COI) data in patients with epilepsy in Germany. METHODS: Data on socio-economic status, course of epilepsy as well as direct and indirect costs were recorded using practice software-based questionnaires. RESULTS: In 2011 we enrolled 359 patients (170 male (47.4%); mean age 50.5±20.7 years) in six neurological practices. The majority of patients had been in long-term seizure remission for more than one year (n=200, 55.7%) and in more than two-thirds the anti-epileptic drug (AED) monotherapy (n=248, 69.1%) was used. Levetiracetam (31%), lamotrigine (26%) and valproate (24%) were the drugs prescribed most frequently. Total annual direct costs amounted to €1698 per patient with anticonvulsants (59.9% of total direct costs) and hospitalization (30.0%) as the main cost factors. Of the patients enrolled 252 (70.2%) were of working age and indirect annual costs due to absenteeism amounted to €745 per patient. Potential cost-driving factors were seizure frequency and a recent diagnosis of epilepsy associated with higher costs. Anticonvulsant treatment in patients aged 65 years and older was associated with lower drug costs due to prescription of older AEDs. CONCLUSION: We were able to demonstrate that electronic practice management software can easily be used to perform long-term health economic evaluations with a bottom-up approach. The combination of both physician- and patient-based electronic databases will facilitate performing less expensive studies, but at the same time simplify large, prospective and multicentre clinical trials.

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.

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.

The effect of functional endoscopic sinus surgery on pulmonary improvement of controlled asthmatic patients with chronic sinusitis.

The relationship between asthma and sinusitis has been proposed in many reports but the role of sinus surgery in their treatment is still controversial. Therefore, the effect of functional sinus surgery in patients with controlled asthma was evaluated. Fifty six patients with a history of sinusitis in whom maximum medical treatment had failed and also those with a history of asthma who were in a stable condition at time of surgery and were candidates for endoscopic sinus surgery were selected. All those who underwent functional endoscopic sinus surgery were re-evaluated at last one year later for pulmonary and sinus status. The patients' characteristics were prospectively recorded during the study period from January 2007 to November 2009. Finally, the results of the assessments were analyzed. Among 56 studied patients, 35 (62.5%) were female and 21 (37.5%) male. Preoperative imaging, evaluated according to Lund Mac Kay score, had a mean score of 19.5±5. The average effect of FESS in asthma improvement was 69.6%. Asthma improvement had a significant relationship with the duration of asthma and sinusitis before surgery. Functional endoscopic sinus surgery can effectively treat sinusitis in asthmatic patients. Earlier intervention in the course of pulmonary disease may warrant a better outcome.

Effect of intermittent light on photoreceptor cells in the rabbit retina.

PURPOSE: The objective of the present study was to determine what histological changes occur in the photoreceptor layer of male rabbits exposed to intermittent light of different intensities. METHODS: Twelve adult male rabbits were randomly divided into three groups: control group (CON), experimental group I (EXP-1), and experimental group II (EXP-2). The EXP-1 and EXP-2 groups were exposed to a 3-h/3-h light-dark cycle, with light provided by a 60-W or 200-W fluorescent bulb, respectively. The eyes of the rabbits were removed, routinely fixed, and studied by transmission electron microscopy. RESULTS: The EXP-1 rabbits showed the least photoreceptor damage, such as only slight vacuolization in the inner segment, but normal appearance in the other layers. The EXP-2 rabbits showed disorganization and distention in the outer segments and sublethal injury in the inner segment, such as vacuolization, mitochondrial distention and disorganization, increased extracellular space, and distention of cisternae in the rough endoplasmic reticulum. In the EXP-2 group, the outer limiting membrane was absent at some sites, and swelling and pyknosis were present. CONCLUSIONS: These observations suggest that intermittent high-intensity light causes more damage in the photoreceptor layer of the rabbit than does intermittent low-intensity light.

Mediastinal mass evaluation using advanced robotic techniques.

The diagnosis and management of mediastinal masses frequently necessitates biopsy and surgical resection. The use of videothorascopic techniques has broadened the surgeon's ability to evaluate and treat such tumors using a minimally invasive approach. We describe herein the use of the da Vinci Robotic Surgical System for evaluating a mediastinal mass in a young woman.