Combination of spironolactone and sitagliptin improves clinical outcomes of outpatients with COVID-19: a prospective cohort study.

BACKGROUND: There are evidences showing that sitagliptin and spironolactone can potentially improve the clinical outcomes of COVID-19 cases. In this observational study on acutely symptomatic outpatient COVID-19 cases, we investigated the effects of spironolactone and sitagliptin on the outcomes of the disease. METHODS: This is a prospective, naturally randomized cohort study. We followed mild to moderate symptomatic COVID-19 patients, who were treated with either combination (spironolactone 100 mg daily and sitagliptin 100 mg daily) or standard (steroid, antiviral and/or supportive care) therapy up to 30 days. The primary outcome was hospitalization rate. The secondary outcomes included ER visit, duration of disease, and complications, such as hypoglycemia, low blood pressure or altered mental status. RESULTS: Of the 206 patients referred to clinics randomly, 103 received standard therapy and 103 treated with combination therapy. There were no significant differences in baseline characteristics, except for slightly higher clinical score in control group (6.92 ± 4.01 control, 4.87 ± 2.92 combination; P < 0.0001). Treatment with combination therapy was associated with lower admission rate (5.8% combination, 22.3% control; P = 0.0011), ER visits (7.8% combination, 23.3% control; P = 0.0021) and average duration of symptoms (6.67 ± 2.30 days combination, 18.71 ± 6.49 days control; P ≤ 0.0001). CONCLUSIONS: The combination of sitagliptin and spironolactone reduced duration of COVID infection and hospital visits better than standard therapeutic approaches in outpatients with COVID-19. The effects of combination of sitagliptin and spironolactone in COVID-19 patients should be further verified in a double-blind, randomized, placebo-controlled trial.

Brucellosis as a neglected disease in a neglected population: a seroepidemiological study of migratory nomads in the Fars province of Iran.

This study assessed the seroprevalence of brucellosis and its risk factors in migratory nomads in the Fars province of Iran. Active brucellosis was defined as the combination of clinical symptoms, including fever, chills, night sweats, headache, low back pain, arthralgia, or myalgia, and positive laboratory testing, including either a serum agglutination test (SAT) ⩾1:80 with a 2-mercaptoethanol (2-ME) test ⩾1:40, or a SAT <1:80 combined with a positive Coombs Wright test (CWT) at a titre of at least threefold higher than SAT titre results. For the 536 participants, the female (316, 59%) to male (220, 41%) ratio was 1·4 and the participants' mean age was 32·4 ± 18·9 (range 1-96) years. Of all participants, 325 (60·6%) showed clinical symptoms; in symptomatic participants, the Rose Bengal plate test was positive in 33 (6·1%) cases, the SAT was positive in 18 (3·3%) cases, and the 2-ME test was positive in 30 (5·5%) cases. Positive SAT and 2-ME results were seen in 18 (3·3%) cases, but a negative SAT and a positive CWT were found in 36 (6·7%) cases. As a result, active brucellosis was detected in 54 cases, indicating a prevalence of 10% (95% confidence interval 8-12). In conclusion, we determined that brucellosis is a prevalent yet neglected disease in this nomadic population. Brucellosis control is not possible as long as these high-risk populations remain neglected.

Bacterial etiology and antibiotic resistance pattern of septicemia in HIV and non-HIV patients admitted to tertiary care hospitals, Shiraz, South of Iran.

The present study aimed to determine the bacteriological etiology and antibiotic susceptibility pattern of sepsis in HIV infected and HIV uninfected patients, and related risk factors to introduce an appropriate therapy. This cross-sectional study was conducted from January 2014 to January of 2015 enrolling patients with sepsis associated with or without HIV infection admitted to Shiraz teaching hospitals, South of Iran. Blood and urine cultures were performed and standard microbiological methods were followed for isolation and identification of the bacteria. HIV antibody testing and CD4+ lymphocyte count were done for HIV-infected patients. Antimicrobial susceptibility tests were performed using the disk diffusion method in accordance with CLSI recommendations. Totally, 140 patients with sepsis including 30 HIV-positive, and 110 HIV-negative were enrolled. Our finding showed 26.7% and 20% blood and urine culture positivity in HIV-positive and 20.9% and 14.5% positivity in HIV-negative patients. Staphylococcus aureus, Salmonella spp. and coagulase-negative staphylococci (CoNS) each with frequency of 25% were detected as the most prevalent isolates in samples of HIV patients. In contrast, the main etiology for sepsis in HIV-negative patients was CoNS (47.8%), followed by Escherichia coli (17.4%). The median of CD4+ lymphocyte count and viral load in HIV patients were estimated 10.15 cells/mm3 and 68019.48 copies/mL, respectively. The results of the present study revealed that the main cause of sepsis in the studied hospitals was nosocomial pathogens. These findings highlighted the importance of infection control policies for preventing the emergence and spread of nosocomial infections.

Establishment of a fast and high yield method for routine production of [(131) I]MIBG and investigation of its radiochemical stability for diagnosis and treatment uses.

In this work, exchange radioiodination of metaiodobenzylguanidine (MIBG) was carried out at optimum conditions that facilitates the production of [(131) I]MIBG both quickly and efficiently. The radiochemical purity and yield of the labeled product are typically as high as 99% and 90% for diagnostic dose and 95% and 80% for therapeutic dose, respectively. Stability studies show that labeled material at the room temperature met the demand of the clinical application. This labeling procedure will be used in the routine production process of [(131) I]MIBG for diagnosis and treatment uses.

High prevalence of HCV coinfection in HIV-infected individuals in Shiraz, Islamic Republic of Iran.

We carried out a cross-sectional survey in Shiraz to determine the prevalence of hepatitis C virus (HCV) in 1 444 individuals infected with human immunodeficiency virus (HIV). We also determined the risk factors for this coinfection. Demographic and behavioural data were obtained using a standard questionnaire. The prevalence of HIV-HCV coinfection was 78.4% (95% CI: 76.3-80.5). Intravenous drug use (OR = 7.2; 95% CI: 4.9-10.6), imprisonment (OR = 6.9; 95% CI: 4.6-10.4), tattooing in prison (OR = 2.61; 95% CI: 1.4-4.8), tattooing out of prison (OR = 2.0; 95% CI: 1.3-3.1) and age (OR = 1.02 with increasing each year of life; 95% CI: 1.0-1.04) were significantly associated with HCV-HIV coinfection. Prevalence of HCV-HIV coinfection is high in Shiraz. Intravenous drug use and imprisonment are the main risk factors for this coinfection. Therefore, serious implementation of HIV and HCV testing, education, prevention, care and treatment programmes and evaluation of harm reduction programmes in prisons are very important.

[Computer-assisted implantology]. / Implantologie assistée par ordinateur.

We had for aim to present the three applications of computer-assisted implantology: preoperative exploration of the surgery site, guided surgery, and preparation of the temporization prosthesis before surgery. Cases are presented for each indication and their clinical relevance is discussed.

[Unconventional transradicular implant placement to avoid invasive surgeries: toward a potential paradigm shift]. / Protocole non conventionnel de mise en place d'implants transradiculaires. Esquisse d'un changement de paradigme.

The authors had for aim to present a new minimally-invasive protocol to rehabilitate anterior maxillary edentulism due to an impacted tooth. The implant is placed without removing the impacted tooth, which intercepts the implant trajectory. The inclusion/exclusion criteria have not been defined yet but this protocol goes against the consensual concept that no implant surface other than implant-bone interface should be tolerated. New implant-tissue interfaces are created in addition to the usual one, but this does not seem to jeopardize the prognosis of implants. The risk analysis shows that there is a growing corpus of reliable clinical and histological data to support this unconventional protocol. The overall follow-up covers from a 6-month to an 8-year period. This protocol should be more broadly documented before it can be used routinely; nevertheless it suggests that some of the leading concepts in dental implantology may be revisited.

Evaluation of prophylactic antibiotic administration at the surgical ward of a major referral hospital, Islamic Republic of Iran.

We evaluated the appropriateness of antibiotic prophylaxis administered before surgery at a major referral hospital in Shiraz, against the American Society of Hospital Pharmacists (ASHP) guidelines. Data on surgical procedure, choice of antibiotic and administration were gathered for all surgeries performed on hospitalized patients during 15 days in March 2010. Of 155 patients included in the analysis, 98% received prophylactic antibiotic before surgery; according to ASHP guidelines, prophylaxis was needed in only 106 (68.4%). Of these 106, only 8 patients received the correct antibiotic regimen. The commonest regimens administered were cefazolin + gentamicin (47.6%), cefazolin (20.5%) and cefuroxime (8.5%). Antibiotic prophylaxis was continued in 83% of cases, while this was necessary in only 37%. In only 1 surgical procedure were all evaluated parameters correct.

Proposing an intelligent approach for measuring the thickness of metal sheets independent of alloy type.

Radiation based gauges have been widely utilized as a nondestructive and robust tool for measuring the thickness of metal sheets in industry. The typical radiation thickness meter can just work accurately when the composition of the material is fixed during the measurement process. In conditions that material composition may differ substantially from the nominal composition, such as manufacturing rolled metals factories, the thickness measurements would be along with errors. The purpose of the present research is resolving the problem of measuring the thickness of metal sheets with various alloys. The aluminum is investigated in this work as a case study but the procedure can be applied for other types of metals. As the first step, the performance of various arrangements of two main detection techniques, named dual energy and dual modality, were investigated using MCNPX code to obtain optimum technique and arrangement. The simulation results indicated that a binary combination of 241Am-60Co isotopes as the source and one transmission detector in dual energy technique is the most appropriate choice. After then, an experimental setup based on the obtained optimal technique from simulation investigations was established. The aluminum sheets with 4 alloy types of 1050, 3105, 5052 and 6061 and thicknesses in the range of 0.2-4 cm with a step of 0.2 cm were tested and the obtained data were implemented for testing and training the artificial neural network (ANN). The proposed methodology could predict the thickness of aluminum sheet independent of its alloy type with an error of less than 0.04 cm in experiments.

Brainstem auditory evoked potential (BAEP) in brucellosis.

BACKGROUND: Brucellosis is a zoonosis still endemic in many parts of the world including coastal countries of Mediterranean Sea, Middle East regions and Central and South America. Now in this study we surveyed whether patients with systemic brucellosis, BAEP differ from healthy persons or not. This will help us later, when the patients with brucellosis refer to perform BAEP to prevent misdiagnosis. MATERIALS AND METHODS: Fifteen patients with acute systemic brucellosis without neurological involvement and 15 apparently healthy persons underwent a brainstem auditory evoked potentials (BAEP) study. RESULTS: Comparison of pooled data between the systemic brucellosis and healthy groups showed no significant differences in all BAEP parameters. CONCLUSION: In conclusion, BAEP parameters in brucellosis group did not differ from healthy persons. Thus in interpretation of BAEP in patients that referred for another reason and have systemic brucellosis, it is not necessary to consider about the effect of brucellosis on BAEP.

Study and full simulation of ten different gases on sealed Multi-Wire Proportional Counter (MWPC) by using Garfield and Maxwell codes.

In this research gas sealed Multi-Wire Proportional Counter (MWPC) including blades between anode wires and beta particles of (90)Sr with 196keV mean energy were considered. Ten different gases such as Noble gases mixtures with methane and several other pure gases were studied. In this type of detector, by using Garfield and Maxwell codes and for each of the gases, variation of different parameters such as first Townsend, electron attachment coefficients with variable electric field and their effects on pulse height or collected charge and in turn on Signal to Noise Ratio (SNR) were studied. Also the effect of anode voltage and its diameter and the pressure of gas on the pulse height were studied. Results show that Garfield and Maxwell codes can be used to study and improve the design of other gaseous detectors.

Implant treatment of posterior mandibular sextants.

In mandibular posterior sextants an insufficient bone quality or volume may contraindicate implant placement. Crestal bone resorption, supra-eruption of teeth, and minimal bone coronal to the mandibular canal are the principal reasons for not placing dental implants. The available prosthetic space is also a major factor in determining surgical and prosthetic treatment. Various surgical approaches are used to create adequate bone volume in the posterior mandible, thereby allowing the possibility for implant placement. The therapeutic choice is made depending upon residual bone volume and available prosthetic space. The risks and disadvantages of the various techniques must be seriously evaluated and explained to the patient.

Osseotite implant: 3-year prospective multicenter evaluation.

PURPOSE: This prospective multicenter study evaluates the cumulative success rate of the Osseotite implant after 3 years of prosthetic loading. MATERIALS AND METHODS: A total of 413 Osseotite implants (Implant Innovations) were placed in 142 patients (completely or partially edentulous) in five dental offices exclusively devoted to implants. The average age of the patients was 58.3 years. Of the 413 implants, 191 were placed in the maxilla and 222 in the mandible; 271 (65.6%) were posterior implants and 142 (34.4%) were anterior implants. Clinical and radiographic evaluations were made after completion of the prosthetic restoration, after 6 months of loading, at 1 year, and at 3 years. RESULTS: A cumulative success rate of 95.3% was obtained after 3 years of prosthetic loading. The success rate was similar in both arches: 95.1% in the maxilla and 96.8% in the mandible. Early failures (before prosthetic loading) were greater (n = 12) than late failures (n = 2). After 3 years of prosthetic loading, the marginal bone level of 385 (93.2%) implants were evaluated radiographically. Bone level was at the first thread for 91.4% of the implants. A slightly increased loss was observed around 26 implants (6.7%). Including survival implants, the cumulative implant success rate after 3 years was 96%. A success rate of 98.4% was obtained with 187 short implants (8, 5 and 10 mm) reported in this multicenter evaluation. CONCLUSION: This multicenter evaluation demonstrates excellent predictability for Osseotite implants.

Apical-coronal implant position: recent surgical proposals. Technical note.

The conventional placement protocol for submerged and non-submerged implants was proposed in the 1960s and 1970s. Multicenter studies have reported satisfactory success rates for both protocols and a similar loss of crestal peri-implant bone after implant loading (0.5 to 1.5 mm). In recent years, placement of submerged implants using a single surgical procedure was introduced, with the immediate placement of a healing abutment. Some studies reported good short-term results using this approach. Recently, a supracrestal apical-coronal positioning of the implant collar has been proposed for posterior sectors using submerged implants. This positioning facilitates the second surgical phase, as well as fabrication of the prosthetic restoration, and limits the amount of crestal bone loss.

Dental implants in the oral rehabilitation of a teenager with hypohidrotic ectodermal dysplasia: report of a case.

This report presents the case of a teenager affected by hypohidrotic ectodermal dysplasia and rehabilitated with a fixed maxillary partial prosthesis and mandibular overdenture supported by osseointegrated implants. Treatment had a major impact on patient's self-esteem, function, and esthetics.

The self-tapping and ICE 3i implants: a prospective 3-year multicenter evaluation.

This multicenter prospective clinical evaluation was undertaken to determine the therapeutic success and marginal bone level stability of 3i's self-tapping and ICE implants after 3 years of prosthetic loading. Between July 1995 and June 1996, 189 completely or partially edentulous patients were treated with 614 machined-surface screw-type commercially pure titanium implants (self-tapping or ICE). Two hundred seventy-seven self-tapping implants were placed in 85 patients (average age of 56 years), and 337 ICE implants were placed in 104 patients (average age of 61 years). A total of 360 implants (58.6%) were placed in posterior segments. Easier placement was reported with the ICE implant in normal or dense bone. For the self-tapping implants, survival rates of 92.9% and 91.6% were noted after 1 and 3 years of prosthetic loading, respectively. Survival rates of 95.4% and 93.8% were obtained with the ICE implant for the same periods. Late failures (after loading) were more common than early failures (before loading) for both types of implants. The marginal bone level of 238 self-tapping implants (85.9%) and of 307 ICE implants (91%) was radiographically evaluated at 3 years. Marginal bone level was at the first thread for 95.1% of implants. A loss of marginal bone level of 2 to 4 threads was noted for 4.9% of the evaluated implants. No implant showed bone loss greater than the fourth thread. Overall survival rates of 94.3% and 92.9% were obtained after 1 and 3 years of prosthetic loading, respectively, for 596 and 588 implants.

Wide-diameter implants: new concepts.

At the end of the 1980s, it was suggested that wide-diameter implants be used to better the prognosis in cases in which the condition of the supporting bone is unfavorable. Technical improvements associated with different shapes and materials used for implants have led to an evolution of our concepts of surgical and prosthetic treatments. The aim of these new suggestions is to optimize the functional and esthetic result while respecting the fundamental principles of osseointegration. Up to the present time, very few studies have been published on wide-diameter implants. However, the short- and medium-term results that have been reported have been very satisfactory.

The modified osteotome technique.

Patients who have been partially edentulous in the posterior segments for many years frequently present with reduced alveolar bone and/or enlarged sinuses. The choice of treatment for these patients will depend on the volume of residual bone, morphology of the alveolar crest, and amount of space available for the prosthesis. A new, minimally invasive surgical procedure using Summers osteotomes is described for the treatment of the edentulous posterior maxilla in which the bone thickness below the sinus is limited (> or = 5 mm). This suggested modified treatment is based on the use of a combination of osteotomes, drills, and screw-type implants with a rough surface texture.

To conserve or implant: which choice of therapy?

The longevity of teeth depends directly on the state of the periodontal tissues. Many etiologic factors can lead to the loss of a tooth. Tooth loss is frequently associated with bone resorption. The diagnosis of a condition and knowledge of its etiology are essential to assess the prognosis of the remaining teeth and to formulate the correct treatment plan. Many parameters must be investigated to ascertain an accurate diagnosis. An understanding of the patient's needs and the length and likely success of treatment guides the decision of whether to preserve teeth or extract them and place implants. Advanced periodontitis poses a major therapeutic dilemma. Judicious, strategic extractions may permit the placement of long implants in ideal positions.

Guided tissue regeneration around dental implants in immediate extraction sockets: comparison of e-PTFE and a new titanium membrane.

To evaluate the efficacy of guided tissue regeneration around exposed implant threads, 16 implants were placed into fresh extraction sockets in beagle dogs. Polytetrafluoroethylene (e-PTFE) membranes and titanium membranes were used to cover the defects around implants. A control group did not receive any membranes. Results were evaluated histologically. The average gain in bone height was 2.1 mm for e-PTFE sites, 0.8 mm for titanium membranes, and 2.9 mm for control sites. The greatest gain in bone levels was seen for two sites that received e-PTFE membranes and remained covered for the entire evaluation interval. Within the limits of this study, clinical and histologic evidence demonstrated that, when primary coverage is maintained, the use of e-PTFE membranes can significantly enhance bone regeneration around implants.