Text mining of hypertension researches in the west Asia region: a 12-year trend analysis.

More than half of the world population lives in Asia and hypertension (HTN) is the most prevalent risk factor found in Asia. There are numerous articles published about HTN in Eastern Mediterranean Region (EMRO) and artificial intelligence (AI) methods can analyze articles and extract top trends in each country. Present analysis uses Latent Dirichlet allocation (LDA) as an algorithm of topic modeling (TM) in text mining, to obtain subjective topic-word distribution from the 2790 studies over the EMRO. The period of checked studied is last 12 years and results of LDA analyses show that HTN researches published in EMRO discuss on changes in BP and the factors affecting it. Among the countries in the region, most of these articles are related to I.R Iran and Egypt, which have an increasing trend from 2017 to 2018 and reached the highest level in 2021. Meanwhile, Iraq and Lebanon have been conducting research since 2010. The EMRO word cloud illustrates 'BMI', 'mortality', 'age', and 'meal', which represent important indicators, dangerous outcomes of high BP, and gender of HTN patients in EMRO, respectively.

On Therapeutic Plasma Exchange Against Severe COVID-19-Associated Pneumonia: An Observational Clinical Study.

Background: There is a risk of novel mutations of SARS-CoV-2 that may render COVID-19 resistant to most of the therapies, including antiviral drugs and vaccines. The evidence around the application of therapeutic plasma exchange (TPE) for the management of critically ill patients with COVID-19 is still provisional, and further investigations are needed to confirm its eventual beneficial effects. Aims: To assess the effect of TPE on the risk of mortality in patients with COVID-19-associated pneumonia, using three statistical procedures to rule out any threats to validity. Methods: We therefore carried out a single-centered retrospective observational non-placebo-controlled trial enrolling 73 inpatients from Baqiyatallah Hospital in Tehran (Iran) with the diagnosis of COVID-19-associated pneumonia confirmed by real-time polymerase chain reaction (RT-qPCR) on nasopharyngeal swabs and high-resolution computerized tomography chest scan. These patients were broken down into two groups: Group 1 (30 patients) receiving standard care (corticosteroids, ceftriaxone, azithromycin, pantoprazole, hydroxychloroquine, lopinavir/ritonavir), and Group 2 (43 patients) receiving the above regimen plus TPE (replacing 2 l of patients' plasma by a solution, 50% of normal plasma, and 50% of albumin at 5%) administered according to various time schedules. The follow-up time was 30 days and all-cause mortality was the endpoint. Results: Deaths were 6 (14%) in Group 2 and 14 (47%) in Group 1. However, different harmful risk factors prevailed among patients not receiving TPE rather than being equally split between the intervention and control group. We used an algorithm of structural equation modeling (of STATA) to summarize a large pool of potential confounders into a single score (called with the descriptive name "severity"). Disease severity was lower (Wilkinson rank-sum test p < 0.001) among patients with COVID-19 undergoing TPE (median: -2.82; range: -5.18; 7.96) as compared to those not receiving TPE (median: -1.35; range: -3.89; 8.84), confirming that treatment assignment involved a selection bias of patients according to the severity of COVID-19 at hospital admission. The adjustment for confounding was carried out using severity as the covariate in Cox regression models. The univariate hazard ratio (HR) of 0.68 (95%CI: 0.26; 1.80; p = 0.441) for TPE turned to 1.19 (95%CI: 0.43; 3.29; p = 0.741) after adjusting for severity. Conclusions: In this study sample, the lower mortality observed among patients receiving TPE was due to a lower severity of COVID-19 rather than the TPE effects.

Clinical efficacy of convalescent plasma for treatment of COVID-19 infections: Results of a multicenter clinical study.

Since Dec. 2019 the new coronavirus (SARS-CoV-2) has infected millions and claimed life of several hundred thousand worldwide. However, so far no approved vaccine or drug therapy is available for treatment of virus infection. Convalescent plasma has been considered a potential modality for COVID-19 infection. One hundred eighty-nine COVID-19 positive patients including 115 patients in plasma therapy group and 74 patients in control group, registered in the hospitals with confirmed COVID-19 infection, entered this multi-center clinical study. Comparison of outcomes including all-cause mortality, total hospitalization days and patients' need for intubation between the two patient groups shows that total of 98 (98.2 %) of patients who received convalescent plasma were discharged from hospital which is substantially higher compared to 56 (78.7 %) patients in control group. Length of hospitalization days was significantly lower (9.54 days) in convalescent plasma group compared with that of control group (12.88 days). Only 8 patients (7%) in convalescent plasma group required intubation while that was 20 % in control group. This clinical study provides strong evidence to support the efficacy of convalescent plasma therapy in COVID-19 patients and recommends this treatment for management of these patients. Clinical efficacy, immediate availability and potential cost effectiveness could be considered as main advantages of convalescent plasma therapy.

The clinical value of two combination regimens in the Management of Patients Suffering from Covid-19 pneumonia: a single centered, retrospective, observational study.

BACKGROUND: There is no identified pharmacological therapy for COVID-19 patients, where potential therapeutic strategies are underway to determine effective therapy under such unprecedented pandemic. Therefore, combination therapies may have the potential of alleviating the patient's outcome. This study aimed at comparing the efficacy of two different combination regimens in improving outcomes of patients infected by novel coronavirus (COVID-19). METHODS: This is a single centered, retrospective, observational study of 60 laboratory-confirmed COVID-19 positive inpatients (≥18 years old) at two wards of the Baqiyatallah Hospital, Tehran, Iran. Patient's data including clinical and laboratory parameters were recorded. According to the drug regimen, the patients were divided into two groups; group I who received regimen I consisting azithromycin, prednisolone, naproxen, and lopinavir/ritonavir and group II who received regimen II including meropenem, levofloxacin, vancomycin, hydroxychloroquine, and oseltamivir. RESULTS: The oxygen saturation (SpO2) and temperature were positively changed in patients receiving regimen I compared to regimen II (P = 0.013 and P = 0.012, respectively). The serum level of C-reactive protein (CRP) changed positively in group I (P < 0.001). Although there was a significant difference in platelets between both groups (75.44 vs 51.62, P < 0.001), their change did not clinically differ between two groups. The findings indicated a significant difference of the average length of stay in hospitals (ALOS) between two groups, where the patients under regimen I showed a shorter ALOS (6.97 vs 9.93, P = 0.001). CONCLUSION: This study revealed the beneficial effect of the short-term use of low-dose prednisolone in combination with azithromycin, naproxen and lopinavir/ritonavir (regimen I), in decreasing ALOS compared to regimen II. Since there is still lack of evidence for safety of this regimen, further investigation in our ongoing follow-up to deal with COVID-19 pneumonia is underway. Graphical abstract.

Less primary fistula failure in hypertensive patients.

End stage renal disease (ESRD) patients suffer from advanced renal diseases and actually nonfunctioning kidneys, and need kidney transplantation or dialysis. Hemodialysis (HD) is the most used method and requires a vascular access (VA). Arteriovenous fistula (AVF) is the first choice of VA over the world for having least morbidity and mortality. Despite the wide-spread use of AVFs, the rate of AVF failures are notable. Detecting the factors that cause AVF failure can reduce repeating VA surgeries and hospitalization of ESRD patients. Present research studies 480 Iranian HD patients who underwent AVF surgery from 2010 to 2017 and aged 18-90 years old, using data mining techniques. (i) The AVF failure rate was equal to 8.96%, such that AVF failure has occurred in 3.54% and 5.52% of HD patient with and without hypertension, respectively. (ii) The rate of non-failure AVF in hypertensive patients is 61.46%, whereas the same rate for patients with negative history of hypertension reaches to 29.58%. (iii) Hypertension has a significant inverse association with AVF failure (Spearman's ρ = -0.160, P-value ≤ 0.005). (iv) The decision tree (with accuracy rate = 92.24%) shows less AVF failure in hypertsensive patients (5.53%) comparing with non-hypertensive patients (15.09%). (v) The AVFs with greater failure rates and non-hypertensive HD patients were clustered together. "Significantly lower risk of AVF failure was associated with presence of a positive history of hypertension; in other words, positive history of hypertension has an adverse effect on AVF failure and Hypertensive HD patients have more maturated AVF."

A new method to determine anastomosis angle configuration for arteriovenous fistula maturation.

Background: The kidneys of patients with chronic kidney disease (CKD) do not function well enough and those in end-stage renal disease (ESRD) of CKD need hemodialysis (HD) as a common renal replacement therapy (RRT) procedure. HD requires a vascular access (VA), and arteriovenous fistula (AVF) is the common VA choice in the world due to its very few complications. Despite the widespread use of AVFs, some risk factors maximize AVF failure, which is accompanied by complications of the patient such as repeating VA surgeries and hospitalization. Therefore, finding effective factors in the success of surgery is highly important and, thus, this study aimed at measuring the effect of anastomosis angle on the success of AVF surgery. Methods: This study evaluated the effect of conducted angle in an AVF anastomosis on AVF maturation. The images of 48 created AVFs for CKD patients was provided over a one-year period (from May 2016 to April 2017). Cross-tab analysis was used, and significance level was considered meaningful at p-value≤0.001. A centralized database was designed to integrate data. A method for image processing was developed and geometrical characteristics of the vessels (such as anastomosis angle) and also the diameter of artery and vein were measured via AutoCAD 2017 software and exported to the database along with other data. Results: The rate of the AVF failure in the studied patients was 8.96%. The anastomosis angle ≤ 30° is preferable from the AVF status point of view because most AVF maturation (or least AVF failure) rates are detected at this range. Conclusion: This study was performed based on a new approach without the need to measure hemodynamic parameters. Moreover, it signified the important role of anastomosis angle in the function of AVF, showing that the anastomosis angle ≤ 30° is a preferable intraoperative recommendation for AVF surgery.

Roles of triglyceride and phosphate in atherosclerosis of diabetic hemodialysis patients.

Background: A growing number of patients with End-Stage Renal Disease (ESRD) are undergoing long-term hemodialysis (HD). HD needs a vascular access (VA) and complications of VA account for a sizable proportion of its costs. One of the important cardiovascular diseases (CVD) is atherosclerosis, which is a major cause of premature deaths in the world. So, it is essential to find the risk factors to treat them before they cause an obvious CVD. Methods: We analyzed data from 174 ESRD patients who were candidate for Arterio Venous Fistula (AVF) creation from April 2008 to March 2009 in Hasheminejad Kidney Center by convenient sampling. X-ray images were used and C 4.5 algorithm of data mining techniques revealed the roles of two risk factors for atherosclerosis of diabetic ESRD patients. Pearson coefficient was also used to measure the correlation between the parameters. Results: Diabetic patients had significantly more calcified arteries in their forearm X-ray than other patients (p<0.001). Occurrence of atherosclerotic CVD in diabetic HD patients has an adverse relation compared with the controlled levels of their plasma levels of Triglyceride (TG) and Phosphorus. We found an inverse effect of TG and phosphorus plasma levels on the atherosclerotic involvement of radial and ulnar arteries in diabetic HD patients. We observed that the prevalence of radial and ulnar arteries calcification in these patients is lower when they have higher plasma levels of TG and phosphorous. Conclusion: This study investigates the role of high plasma levels of TG and phosphorous in the development of atherosclerosis in diabetic HD patients. Although many studies showed that hypertriglyceridemia plays a promoting role in the development of CVD, our study also found an inverse effect of plasma levels of TG on the atherosclerotic involvement of radial and ulnar arteries in diabetic patients, and therefore our results support this suspicion that hypertriglyceridemia plays a significant role in developing atherosclerosis.

The impact of vascular diameter ratio on hemodialysis maturation time: Evidence from data mining approaches and thermodynamics law.

BACKGROUND: Vascular Access (VA) is an important aspect for blood circulatory in Hemodialysis (HD). Arteriovenous Fistula (AVF) is a suitable procedure to gain VA. Maturation of the AVF is a status of AVF, which can be cannulated for HD. This study aimed to discover the parameters that effectively reduce the duration between VA and start of HD, which symbolizes the maturation time (MT). METHODS: Ninety-six patients who underwent AVF creation were selected for this study. The decision tree method was used based on CART/C4.5 algorithm, which is one of the data mining approaches for data classification. Vascular diameter ratio (VDR) coefficient was obtained (VDR=Artery/Vein diameters). RESULTS: We investigated the relationship between the VDR and MT in this study and found that MT is reversely related to VDR in elderly patients, while this relation was direct in younger patients. CONCLUSION: The analysis revealed a Spearman's correlation coefficient for Vein diameter with MT. MT decreases when diameters of vein and artery are close to one another. This study can help the surgeons to identify high- risk patients who elongate MT for HD.

Molecular sensing using armchair graphene nanoribbon.

In molecular electronics, the conductance strongly depends on the frontier energy levels and spatial orientations of molecules. Utilizing these features, we investigate the electron transport characteristics of conjugated molecules attached on an armchair graphene nanoribbon. The resulting sharp reduction in the transmission which represents molecular fingerprints and the change of the transmission depending on the molecular orientation, are examined in accordance with a unified picture of the Fano-Anderson model. These characteristics, being unique for each molecule, would be applicable to molecular recognition and configurational analysis.

Two dimensional molecular electronics spectroscopy for molecular fingerprinting, DNA sequencing, and cancerous DNA recognition.

Laser-driven molecular spectroscopy of low spatial resolution is widely used, while electronic current-driven molecular spectroscopy of atomic scale resolution has been limited because currents provide only minimal information. However, electron transmission of a graphene nanoribbon on which a molecule is adsorbed shows molecular fingerprints of Fano resonances, i.e., characteristic features of frontier orbitals and conformations of physisorbed molecules. Utilizing these resonance profiles, here we demonstrate two-dimensional molecular electronics spectroscopy (2D MES). The differential conductance with respect to bias and gate voltages not only distinguishes different types of nucleobases for DNA sequencing but also recognizes methylated nucleobases which could be related to cancerous cell growth. This 2D MES could open an exciting field to recognize single molecule signatures at atomic resolution. The advantages of the 2D MES over the one-dimensional (1D) current analysis can be comparable to those of 2D NMR over 1D NMR analysis.

Association between non-matured arterio-venus fistula and blood pressure in hemodialysis patients.

BACKGROUND: Chronic Kidney Disease (CKD) is a complicated kidney problem causing permanent renal failure in progressive stages. The final stage of CKD is called ESRD in which most accepted management is Hemodialysis (HD). Arterio-Venus Fistula (AVF) is the most practical way of making proper access to the blood circulatory system; however, maturation of the AVF is a challenge, since there are number of variables interfering with the whole process. The purpose of this study was to evaluate potentially modifiable factors associated with Maturation Time (MT) after creation of a Vascular Access (VA). METHODS: In this cross-sectional study, a total of 87 patients referred to the Hasheminejad Kidney Center for AVF creation in 2010 were evaluated. Patients were evaluated before and after the AVF creation and risk factors such as history of blood pressure abnormalities, diabetes and congestive heart failure, as well as the successive development of AVF was studied and finally processed using 'data mining' technology. RESULTS: The "Decision Trees" indicated the significant impact of the systolic blood pressure (SBP) in the delay of the patient's AVF maturation. Also, prediction of AVF maturation was made with 70.59% of precision in regard to their BP condition. CONCLUSION: This study demonstrated that monitoring the SBP is one of the important steps in management of the cardiovascular variables producing any delay in the process of the patient's HD. Also the data mining method can discover the hidden relationship between the patient's medical conditions in order to predict the potential disorders.

Implementation of predictive data mining techniques for identifying risk factors of early AVF failure in hemodialysis patients.

Arteriovenous fistula (AVF) is an important vascular access for hemodialysis (HD) treatment but has 20-60% rate of early failure. Detecting association between patient's parameters and early AVF failure is important for reducing its prevalence and relevant costs. Also predicting incidence of this complication in new patients is a beneficial controlling procedure. Patient safety and preservation of early AVF failure is the ultimate goal. Our research society is Hasheminejad Kidney Center (HKC) of Tehran, which is one of Iran's largest renal hospitals. We analyzed data of 193 HD patients using supervised techniques of data mining approach. There were 137 male (70.98%) and 56 female (29.02%) patients introduced into this study. The average of age for all the patients was 53.87 ± 17.47 years. Twenty eight patients had smoked and the number of diabetic patients and nondiabetics was 87 and 106, respectively. A significant relationship was found between "diabetes mellitus," "smoking," and "hypertension" with early AVF failure in this study. We have found that these mentioned risk factors have important roles in outcome of vascular surgery, versus other parameters such as "age." Then we predicted this complication in future AVF surgeries and evaluated our designed prediction methods with accuracy rates of 61.66%-75.13%.