Gastrointestinal basidiobolomycosis - A rare fungal infection: Challenging to diagnose yet treatable - Case report and literature review.

Gastrointestinal Basidiobolomycosis is a rare manifestation of Basidiobolus ranarum infection. In this report, we present two cases of gastrointestinal Basidiobolomycosis. The first patient presented with obstructive symptoms, fever, and weight loss. The diagnosis of Basidiobolomycosis was not made until after surgery, when Liposomal amphotericin-B combined with itraconazole were administered, leading to the resolution of laboratory markers of inflammation and patient's symptoms. The second case involves a young woman who presented with hematochezia, perianal induration, and abdominal pain. The patient had previously been diagnosed with Crohn's disease and treated accordingly, but her symptoms did not improve. Due to the endemicity of tuberculosis in Iran, the patient was treated for TB but still showed no improvement. However, a perianal biopsy sample revealed the Splendore Hoeppli phenomenon and fungal elements in GMS staining, leading to the diagnosis of gastrointestinal Basidiobolomycosis. Treatment with itraconazole and co-trimoxazole led to a significant improvement in symptoms and laboratory indices after one week, including the resolution of perianal induration. The key takeaway from this report is the importance of considering rare infections in the differential diagnosis of gastrointestinal conditions such as IBD and GI obstruction.

Effect of Avena sativa (Oats) on cognitive function: A systematic review of randomized controlled trials.

BACKGROUND AND AIM: The effect of polyphenol-rich diets or supplements on cognitive function remains a contentious topic. The objective of this study was to investigate the effects of Avena sativa (oat extracts) on cognitive function among healthy adults. METHODS: A structured literature search was undertaken using PubMed, Web of Science, and Scopus from the database's establishment until March 17, 2022. Data on cognitive function, regarding accuracy and speed of performance, were gathered from randomized controlled trials (RCTs) that investigated the acute or chronic effects of Avena sativa in healthy subjects. The Cochrane Collaboration risk-of-bias tool was used to assess the quality of included studies. RESULTS: We included six RCTs, of which three were crossover designs, with a total of 287 individuals. Four studies investigated the acute effect of Avena sativa, while two investigated its chronic effect. Acute ingestion of Avena sativa appeared to positively influence the accuracy and speed of performance. While short-term chronic supplementation resulted in a significant improvement in cognitive function, long-term chronic supplementation did not. Overall, the evidence was of average quality. CONCLUSION: Acute supplementation with Avena sativa may improve cognitive function in healthy volunteers. Given the small number of trials included and the disparity of the intervention dose, the conclusions of this study should be interpreted with caution. More high-quality, long-term studies are warranted.

Long-term risk and predictors of cerebrovascular events following sepsis hospitalization: A systematic review and meta-analysis.

Background: Long-term risk and predictors of cerebrovascular events following sepsis hospitalization have not been clearly elucidated. We aim to determine the association between surviving sepsis hospitalization and cerebrovascular complications in adult sepsis survivors. Method: We searched MEDLINE, Embase, Scopus, Web of Sciences, Cochrane library, and Google scholar for studies published from the inception of each database until 31 August 2022. Results: Of 8,601 screened citations, 12 observational studies involving 829,506 participants were analyzed. Surviving sepsis hospitalization was associated with a significantly higher ischemic stroke [adjusted hazard ratio (aHR) 1.45 (95% CI, 1.23-1.71), I 2 = 96], and hemorrhagic stroke [aHR 2.22 (95% CI, 1.11-4.42), I 2 = 96] at maximum follow-up compared to non-sepsis hospital or population control. The increased risk was robust to several sensitivity analyses. Factors that were significantly associated with increased hazards of stroke were: advanced age, male gender, diabetes mellitus, hypertension, coronary artery disease, chronic heart failure, chronic kidney disease, chronic obstruction pulmonary disease, and new-onset atrial fibrillation. Only diabetes mellites [aHR 1.80 (95% CI, 1.12-2.91)], hypertension [aHR 2.2 (95% CI, 2.03-2.52)], coronary artery disease [HR 1.64 (95% CI, 1.49-1.80)], and new-onset atrial fibrillation [aHR 1.80 (95% CI, 1.42-2.28)], were associated with > 50% increase in hazards. Conclusion: Our findings showed a significant association between sepsis and a subsequent risk of cerebrovascular events. The risk of cerebrovascular events can be predicated by patient and sepsis-related baseline variables. New therapeutic strategies are needed for the high-risk patients.

Oral antiviral treatments for COVID-19: opportunities and challenges.

The use of antiviral COVID-19 medications can successfully inhibit SARS-CoV-2 replication and prevent disease progression to a more severe form. However, the timing of antiviral treatment plays a crucial role in this regard. Oral antiviral drugs provide an opportunity to manage SARS-CoV-2 infection without a need for hospital admission, easing the general burden that COVID-19 can have on the healthcare system. This review paper (i) presents the potential pharmaceutical antiviral targets, including various host-based targets and viral-based targets, (ii) characterizes the first-generation anti-SARS-CoV-2 oral drugs (nirmatrelvir/ritonavir and molnupiravir), (iii) summarizes the clinical progress of other oral antivirals for use in COVID-19, (iv) discusses ethical issues in such clinical trials and (v) presents challenges associated with the use of oral antivirals in clinical practice. Oral COVID-19 antivirals represent a part of the strategy to adapt to long-term co-existence with SARS-CoV-2 in a manner that prevents healthcare from being overwhelmed. It is pivotal to ensure equal and fair global access to the currently available oral antivirals and those authorized in the future.

Prognostic Potential of the Controlling Nutritional Status (CONUT) Score in Predicting All-Cause Mortality and Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease: A Meta-Analysis.

Background: As defined by the Controlling Nutrition Status (CONUT) score, the prognostic significance of nutritional status has attracted attention in patients with cardiovascular disease. This meta-analysis aimed to determine the importance of CONUT score for prediction of all-cause mortality and major adverse cardiovascular events (MACE) in adult patients with coronary artery disease (CAD). Methods: Observational studies conducted to evaluate the association of CONUT score with adverse clinical outcomes in patients with CAD were included. We searched MEDLINE, Embase, Scopus, Cochrane library, Google scholar, medRxiv pre-print as well as Science Direct search engine for studies published from the inception of each database until March 21, 2022. Studies reporting the utility of CONUT score in prediction of all-cause mortality and MACE among patients with CAD were eligible. Predictive potential of the CONUT score were summarized by pooling the multivariable adjusted hazard ratio (aHR) with 95% CI for the malnourished vs. normal nutritional status or per point CONUT score increase. Results: Of 2,547 screened citation, nine observational studies involving 81,257 patients with CAD were analyzed. Malnutrition defined by the CONUT score was associated with significantly increased risk of all-cause mortality when compared with the normal nutritional state (aHR for mild, moderate, and severe malnutrition, respectively: (1.21 [95% CI: 1.15-1.27], I 2 = 0%), (1.53 [95% CI: 1.26-1.84], I 2 = 84%), and (2.24 [95% CI: 1.57-3.19], I 2 = 77%). Similarly, moderate (aHR 1.71 [95% CI: 1.44-2.03], I 2 = 0%) and severe (aHR 2.66 [95% CI: 1.82-3.89], I 2 = 0%) malnutrition was associated with a significantly higher risk of MACE compared with the normal nutritional state. Additionally, per point increase in the CONUT score was correlated with 20 and 23% additional risk of all-cause mortality and MACE, respectively. Conclusion: As defined by the CONUT score, malnutrition is an independent predictor of all-cause mortality and MACE in CAD patients. Nutritional assessment with CONUT score could allow clinicians to identify patients with CAD at high risk for adverse clinical outcomes.

COVID-19 vaccinations: The unknowns, challenges, and hopes.

The entire world has been suffering from the coronavirus disease 2019 (COVID-19) pandemic since March 11, 2020. More than a year later, the COVID-19 vaccination brought hope to control this viral pandemic. Here, we review the unknowns of the COVID-19 vaccination, such as its longevity, asymptomatic spread, long-term side effects, and its efficacy on immunocompromised patients. In addition, we discuss challenges associated with the COVID-19 vaccination, such as the global access and distribution of vaccine doses, adherence to hygiene guidelines after vaccination, the emergence of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, and vaccine resistance. Despite all these challenges and the fact that the end of the COVID-19 pandemic is still unclear, vaccines have brought great hope for the world, with several reports indicating a significant decline in the risk of COVID19-related infection and hospitalizations.

Evaluation of molecular apoptosis signaling pathways and its correlation with EBV viral load in SLE patients using systems biology approach.

BACKGROUND: Considerable evidence supports that SLE could be related to apoptotic cells and EBV infection. OBJECTIVE: The aim of this study was to identify the transcriptional signature of EBV infection in SLE patients for survey of the molecular apoptosis signaling pathways. METHODS: The PBMCs gene expression profiles of healthy control and SLE patients were obtained from GEO. Functional annotation and signaling pathway enrichment were carried out using DAVID, KEGG. To validate bioinformatics analysis the changes in genes expression of some of obtained genes, Real time PCR was performed on PBMCs from 28 SLE patients and 18 controls. RESULTS: We found that mean viral load was 6013 ± 390.1 copy/µg DNA from PBMCs in all patients. QRT-PCR results showed that the expression of the DUSP1 and LAMP3 genes which had most changes in the logFC among 4 candidate genes, increased significantly in comparison with control. The consistent expression of LMP2 as viral latency gene involve in apoptosis signaling pathways was detected in SLE patients with EBV viral load and some controls. CONCLUSIONS: The study indicated that some cellular genes may have an important role in pathogenesis of SLE through apoptosis signaling pathways. Beside, EBV infection as an environmental risk factor for SLE may affect the dysfunction of apoptosis.

Meta-Analysis of the Usefulness of Beta-Blockers to Reduce the Risk of Major Adverse Cardiovascular Events in Patients With Stable Coronary Artery Disease Without Prior Myocardial Infarction or Left Ventricular Dysfunction.

Beta-blockers (BBs) are the core of coronary artery disease (CAD) pharmacotherapy and demonstrated a well-established benefit in the treatment of acute myocardial infarction (MI). However, the prophylactic role of BBs to affect adverse outcomes in patients with stable CAD, especially among those without a pervious history of MI or left ventricular dysfunction, is not yet addressed. We aimed to determine the effects of beta-blockers on major adverse cardiovascular events (MACE) in patients with stable CAD without prior MI or left ventricular dysfunction. We searched PubMed, EMBASE, Web of Science, Scopus, Google Scholar, and Cochrane Controlled Trials Register for studies published from inception to March 31, 2021. Two researchers independently reviewed the database searches and selected eligible studies. A third reviewer was consulted whenever necessary. A total of 6 studies were included in the final analysis. BBs therapy did not reduce the risk of a MACE (HR, 1.05; 95% CI, 0.91 to 1.20), MI (HR, 1.13; 95% CI, 0.95 to 1.34), and cardiovascular death (HR, 0.95; 95% CI, 0.79 to 1.14). No statistically significant effect was observed between the participants on beta-blocker and control groups. In conclusion, our meta-analysis did not show the benefit of BBs in reducing MACE among patients with stable CAD without previous history of MI or left ventricular dysfunction.

Prevalence and Type Distribution of Human Papillomavirus Recovered from the Uterine Cervix of Nigerian Women: A Systematic Review and Meta-Analysis

Background: Infection with an oncogenic type of human papillomavirus is a prerequisite for the development of precancerous cervical lesions and its subsequent progression to cervical cancer. With an alarming increase in the detection of other suspicious papillomavirus genotypes in both healthy and women with cervical lesions, there is a need for comprehensive data on cervical papillomavirus infection to address cervical cancer and other associated disease burden, especially in Sub-Sarahan Africa, where the bulk of the problem exists. The present study was conducted to develop comprehensive data on the prevalence and circulating genotypes of human papillomavirus in various risk categories in Nigeria. Methods: A systematic review and meta-analysis of peer-reviewed publications on cervical papillomavirus infection were performed. Relevant data were extracted from eligible studies published in PubMed, Web of Science, Embase, Scopus, and Google Scholar, from inception to July 31, 2019. The random-effect model was used to estimate the pooled prevalence. We identified 327 potential studies and pooled data from 18 studies, involving 5697 women aged 15-86 years. Results: The overall pooled prevalence of cervical papillomavirus infection was 42% (95%CI: 30-54%) in the general population and 37% (95%CI: 25-50%) among women living with HIV/AIDS, with the predominance of genotypes 16, 18, 31, 35, 52, 58 and 45. The highest prevalence was observed in teenagers and young adults and the second peak in women 50 years and above. Conclusion: The prevalence of cervical human papillomavirus infection is cumulatively high in Nigeria and HIV is a strong co-factor. We, therefore, strongly recommend the co-screening of human papillomavirus and cervical cancer and integration of the intervention strategy into the existing HIV-care guideline in Nigeria.

The state of child nutrition in Ethiopia: an umbrella review of systematic review and meta-analysis reports.

BACKGROUND: Malnutrition remains to be a major public health problem in developing countries, particularly among children under-5 years of age children who are more vulnerable to both macro and micro-nutrient deficiencies. Various systematic review and meta-analysis (SRM) studies were done on nutritional statuses of children in Ethiopia, but no summary of the findings was done on the topic. Thus, this umbrella review was done to summarize the evidence from SRM studies on the magnitude and determinants of malnutrition and poor feeding practices among under-5 children in Ethiopia. METHODS: PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and Google Scholar were searched for SRM studies on magnitude and risk factors of malnutrition and child feeding practice indicators in Ethiopia. The methodological quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. The estimates of the included SRM studies on the prevalence and determinants of stunting, wasting, underweight, and poor child feeding practices were pooled and summarized with random-effects meta-analysis models. RESULT: We included nine SRM studies, containing a total of 214,458 under-5 children from 255 observation studies. The summary estimates of prevalence of stunting, underweight, and wasting were 42% (95%CI = 37-46%), 33% (95%CI = 27-39%), and 15% (95%CI = 12-19%), respectively. The proportion of children who met the recommendations for timely initiation of breastfeeding, exclusive breastfeeding during the first 6 months, and timely initiation of complementary feeding were 65, 60, and 62%, respectively. The proportion of children who met the recommendations for dietary diversity and meal frequency were 20, and 56%, respectively. Only 10% of children fulfilled the minimum criteria of acceptable diet. There was a strong relationship between poor feeding practices and the state of malnutrition, and both conditions were related to various health, socio-economic, and environmental factors. CONCLUSION: Child malnutrition and poor feeding practices are highly prevalent and of significant public health concern in Ethiopia. Only a few children are getting proper complementary feeding. Multi-sectoral efforts are needed to improve children's feeding practices and reduce the high burden of malnutrition in the country.