Gastrointestinal presentation in a patient with COVID-19 without respiratory tract symptoms: A case report from Qom, Iran

Introduction: Considering the increasing number of patients referred to gastroenterology clinics, we report a suspected case of coronavirus disease 2019 (COVID-19) with only gastrointestinal (GI) presentation in Qom, Iran. Case Presentation: A 74-year-old man with epigastric pain, diarrhea and vomiting for one week was treated, based on the routine abdominal treatment protocol. Since all GI symptoms were resistant to therapy, we decided to perform laboratory assays for a more accurate diagnosis of the disease. Considering the persistence of abdominal pain and nausea, abdominal and pelvic computed tomography (CT) scans, as well as endoscopy and colonoscopy, were performed. After performing the chest CT scan, we noticed the involvement of the lungs. The patient did not have any respiratory symptoms, and at the time of his hospitalization, the COVID-19 epidemic had been reported in Iran. With the progression of the disease, he started to experience mild fever (38°C). Using a specific COVID-19 kit, he was diagnosed with COVID-19 after precise evaluations. However, without any medications, all of his symptoms subsided after 2-3 weeks. Conclusions: It is important for all physicians to know that some pure GI symptoms, which are resistant to therapy, may be the only symptoms in suspected COVID-19 patients. Timely diagnosis and isolation of these patients can guarantee population to avoid the spread of this highly contagious infection. © 2020, Author(s)

Clinical manifestation of patients who died due to COVID-19; A retrospective study from Qom-Iran

Background: The coronavirus disease 2019 (COVID-19) has become a pandemic health problem worldwide. In this study, we attempted to explain the clinical and laboratories characteristics of non-surviving patients, to identify the probable factors affecting disease progression. Methods: In a retrospective study, we assessed the data from dead adult patients who were hospitalized and laboratory diagnosed with COVID-19 during March 2020. The data were obtained from electronic medical records. Moreover, a checklist including demographic, clinical, laboratorial, imaging, and treatment data was completed for each one of the patients. In case of lack of information, a member of the research team contacted the first-degree relatives via phone. Results: Totally, 50 patients were enrolled in this study. The mean age was 68.0 ± 14.1 years. Of them, 29 (58) patients were male. Notably, the median (IQR) hospitalization time was 4.0 (2.7�6.2) days and the duration between the first symptoms to death was 10.0 (5.0�14.5) days. Also, pre-existing morbidity was reported in 42 (84) patients, and hypertension was the most common one with 28 (54) patients. Interestingly, body temperature more than 37.5°C was reported in only 20 (40) patients. Nevertheless, neutrophilia (�7109/L) and lymphopenia (<1.0 109/L) were observed in 27 (54) and 29 (58) patients, respectively. Also, elevated levels of creatinine, lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were common, which may be indicators of aggravation of the patients� status. Conclusion: Besides age and underlying diseases, elevated creatinine level, neutrophil count, and the inflammatory indices along with the reduced lymphocyte count can be considered as indicators of disease progression. Hence, they should be considered for admission and surveillance of patients. © 2020 Academy of Medical Sciences of I.R. Iran. All rights reserved

MALDI-TOF MS Enables the Rapid Identification of the Major Molecular Types within the Cryptococcus neoformans/C. gattii Species Complex

BACKGROUND: The Cryptococcus neoformans/C. gattii species complex comprises two sibling species that are divided into eight major molecular types, C. neoformans VNI to VNIV and C. gattii VGI to VGIV. These genotypes differ in host range, epidemiology, virulence, antifungal susceptibility and geographic distribution. The currently used phenotypic and molecular identification methods for the species/molecular types are time consuming and expensive. As Matrix-Assisted Laser Desorption Ionization-Time-of-Flight Mass Spectrometry (MALDI-TOF MS) offers an effective alternative for the rapid identification of microorganisms, the objective of this study was to examine its potential for the identification of C. neoformans and C. gattii strains at the intra- and inter-species level. METHODOLOGY: Protein extracts obtained via the formic acid extraction method of 164 C. neoformans/C. gattii isolates, including four inter-species hybrids, were studied. RESULTS: The obtained mass spectra correctly identified 100% of all studied isolates, grouped each isolate according to the currently recognized species, C. neoformans and C. gattii, and detected potential hybrids. In addition, all isolates were clearly separated according to their major molecular type, generating greater spectral differences among the C. neoformans molecular types than the C. gattii molecular types, most likely reflecting a closer phylogenetic relationship between the latter. The number of colonies used and the incubation length did not affect the results. No spectra were obtained from intact yeast cells. An extended validated spectral library containing spectra of all eight major molecular types was established. CONCLUSIONS: MALDI-TOF MS is a rapid identification tool for the correct recognition of the two currently recognized human pathogenic Cryptococcus species and offers a simple method for the separation of the eight major molecular types and the detection of hybrid strains within this species complex in the clinical laboratory. The obtained mass spectra provide further evidence that the major molecular types warrant variety or even species status

A mathematical method to study CO₂-CH₄separation in a hollow fibre module

274-281In this work a counter current hollow fibre module with feed entering to shell was studied in order to separate carbon dioxide from methane. New mathematical methods for prediction of specifications of permeate and retentate streams at various conditions were developed. The effects of operating and design variables on module efficiency for a mixture of CO2 and CH4 were studied. It was found that sweep pressure has inverse and direct effects on the CH4 concentration in the retentate and permeates streams, respectively. The opposite effect was observed for CO2

Evaluation of Pressure Distribution in Buried Pipes with Liquid in the Explosion

In this Paper, a parametric study on pipes buried in soil was performed illustrating the results of blast loading. Effects of various parameters such as the physical properties of water, oil, gas, air, soil, pipes, and TNT have been investigated. The arbitrary Lagrangian-Eulerian (ALE) method was employed using LS-DYNA software. The maximum pressure in a buried pipe explosive was observed at an angle of about 0° to 45° and the minimum pressure occurred at an angle of about 45° to 90°. Therefore, all figures in this study illustrate that fluid pressure levels in buried pipes can help in their stabilization. In generally, by increasing the 1.23 times of liquid density under the explosion, the pressure levels in the soil decreased by 1.3 percent. The gas pressure has been increasing more than oil and water pipes 39.73 and 40.52 percent, respectively

Determining the Critical Risk Factors of Implementing Public–Private Partnership in Water and Wastewater Infrastructure Facilities: Perspectives of Private and Public Partners in Iran

Due to the fact that risks can cause project delays and increase project implementation costs, successful construction project completion requires effective and holistic risk management. Identification and evaluation of critical risk factors (CRFs) associated with different types of projects are the most significant components of accurate risk management. This study aims to identify and evaluate the CRFs inherent with private–public partnership (PPP) projects specifically for the development of water and wastewater infrastructure (WWI) facilities in the developing country of Iran. In this line, a comprehensive literature analysis was undertaken to extract the CRFs in applying PPP projects for the development of infrastructure projects in developing countries in general. Then, four rounds of a Delphi survey were conducted to consolidate the major risks to the circumstances of Iran and WWI facilities. There were a total of 35 risks that were grouped into six categories. The main risks were then analyzed and ranked using the Measurement Alternatives and Ranking according to the Compromise Solution (MARCOS) technique. The overall ranking results of the various CRFs revealed that “lack of trust in government’s economic programs” risk was ranked first in terms of importance, followed by the risk of “delay in timely fund payment for project financing and credits,” and the risk of “delay in finalizing bank negotiations.” The overall ranking of the risks placed “economic changes, such as inflation, increase or decrease in prices, and exchange rate” risk in the bottom position. According to the risk ranking findings based on the opinions of private experts, “lack of commitment to the project schedule” was placed first. Conversely, experts from the public sector considered “choosing the wrong financing method” to be the most CRF. It is anticipated that the key research findings and effective recommendations of this study will considerably contribute to the smooth development and remarkable improvement of risk management in applying PPP for WWI facilities in developing countries while enhancing different stakeholders’ understanding of the CRFs for PPP projects, particularly towards WWI services in Iran

Identification of Novel Hybrids Between Cryptococcus neoformans var. grubii VNI and Cryptococcus gattii VGII

Cryptococcusneoformans and Cryptococcusgattii are pathogenic yeasts causing meningoencephalitis in immunocompromised and immunocompetent hosts. The fungus is typically haploid, and sexual reproduction occurs normally between individuals with opposite mating types, α and a. C. neoformans var. grubii (serotype A) is comprised of molecular types VNI, VNII, and VNB, and C. neoformans var. neoformans (serotype D) contains the molecular type VNIV. Additionally, diploid or aneuploid AD hybrids (VNIII) have been reported. C. gattii contains the molecular types VGI, VGII, VGIII, and VGIV, which encompass both serotypes B and C. To identify possible hybrid strains, URA5-RFLP analysis was performed on 350 globally obtained clinical, environmental, and veterinary isolates. Four clinical isolates from cerebrospinal fluid showed combination patterns of C. neoformans var. grubii and C. gattii: Brazil (n = 2), Colombia (n = 1), and India (n = 1). These strains were monokaryotic and diploid or aneuploid. M13 PCR fingerprinting showed that they contained fragments of both proposed parental groups. Luminex IGS genotyping identified these isolates as hybrids with two different molecular type combinations: three VNI/VGII and one VNI/VGI. Blue color development on CGB agar was delayed in three isolates and absent in one. C. gattii-specific PCR confirmed the presence of C. gattii in the hybrids. CAP59 allele-specific PCR revealed that all the hybrids contained both serotype A and B alleles. Determination of mating-type allelic patterns by PCR revealed that the isolates were αA aB. This is the first study discovering novel natural hybrids between C. neoformans molecular type VNI and C. gattii molecular type VGII. © 2011 Springer Science+Business Media B.V