Evaluation of Central Corneal Thickness after Cataract Surgery in Eyes with Pseudoexfoliation Syndrome

Purpose: To compare central corneal thickness after phacoemulsification in patients with and without pseudoexfoliation syndrome.Patients and Methods: A total of 130 eyes who were candidates for phacoemulsification (60 eyes with pseudoexfoliation syndrome and 70 eyes without pseudoexfoliation syndrome) in Shahid Sadoughi Hospital, Yazd, Iran were included in this prospective study. Before the surgery and one day postoperatively CCT were measured in all eyes using Lenstar LS 900 biometer (Haag-Streit(®)) and compared between the case and control groups. Results: Central corneal thickness before surgery was not significantly different between two groups (509 ± 29.28 µm in study group and 516 ± 32.11 µm in the control group, P = 0.27). Postoperatively, CCT in pseudoexfoliation group (589 ± 36.91 µm) was significantly higher than the control group (553 ± 32.77 µm) (P ˂ 0.001).  Conclusion: The mean central corneal thickness was significantly higher in patients with pseudoexfoliation compared to patients without pseudoexfoliation after cataract surgery. We suggest that phacoemulsification in cataract surgery candidates with pseudoexfoliation should be performed more carefully and with special considerations

Inequities as a social determinant of health: Responsibility in paying attention to the poor and vulnerable at risk of COVID-19

To the Editor In December 2019, in Wuhan, Hubei province, China, a disease of viral origin was identified among people working in or around the seafood and animal market. Covid-19 is a causative agent of acute respiratory syndrome.  Almost 26-36% of patients need special care and about 4-15% of them die. Due to the lack of vaccines and effective treatment, the best way to prevent its spread is to quarantine patients and track their contact with other people in the community, trying to reduce mortality and protect the elderly, the vulnerable and special patients..

Two different concentrations of propofol and ketamine combinations in pediatric patients under intrathecal injection of chemotherapy drugs

Background: Intrathecal injection of chemotherapy drugs in leukemic children is a painful procedure that needs sedation and analgesia. Different combinations of ketamine and propofol (ketofol) are used for this purpose. In this study we compared two different concentrations of ketofol    (combination of 1/3 and 1/5 of ketamine and propofol). Methods: In this randomized double blinded controlled clinical trial, 80 Children were studied in two groups. Group 1 received a combination of 1/3 of ketamine and propofol and group 2 received a combination of 1/5 for procedure of Intrathecal injection of chemotherapy drugs. Hemodynamic parameters, recovery time, and drug side effects were compared between two groups.Results: In this study 80 children age 4-12 years old underwent Intrathecal injection of chemotherapy drugs were studied. There were no significant differences in age, weight between groups.  Recovery time was significantly shorter in group 2 (p = 0.001). Also heart rate was lower in group 2 significantly (p = 0.001), but mean arterial pressure was not different between two groups (p = 0.287). SPO2 was > 95% in all the children during the procedure (p = 0.74).Conclusions: Combination of 1/5 of ketamine and propofol (ketofol) for sedation in the children undergoing intrathecal injection of chemotherapy drugs is better than a combination of 1/3 because of shorter recovery time and lower heart rate.

Decolourisation of Beet Sugar Syrup Using Activated Carbon and Glucose Oxidase Enzyme

This paper presents the development and optimization of a new approach which combines the utilization of activated carbon and glucose oxidase enzyme for decolourisation of beet sugar syrup. The combining of the physical adsorption with the enzymatic reaction was managed to improve the decolourisation of beet sugar syrup from 35.29 to 83.68% compared to the basic adsorption by activated carbon after 120 min of operation under the optimum conditions. The maximum decolourisation efficiency by the coupled process was achieved at glucose oxidase dosage of 0.07 g, glucose concentration of 20 mM, and solution pH 7 at the temperature of 30ºC using 0.01 g of activated carbon particles. Given the high effectiveness, reusability, and the eco-friendly nature of the process, the proposed method can serve as an alternative to ordinary decoloursation techniques

The Prevalence of Renal Scar in Urinary Tract Infection Using Dimercaptosuccinic Acid (DMSA) Scan, and Related Factors in Children under 16 Years Old during the Years 2012-2016 in Sari City, Iran

Background: Urinary tract infection is one of the main causes of renal scar that can lead to serious complications such as hypertension or chronic renal failure. Therefore, accurate and timely diagnosis of urinary tract infection and other risk factors related to scar is very important. This study aimed to determine the prevalence of renal scar using dimercaptosuccinic acid (DMSA) scan after urinary tract infection in children under 16 years old in Bu Ali Sina hospital located in Sari City, Iran, during the years 2012 to 2016. Methods: In this cross-sectional study, the data were extracted from files related to those patients suffering UTI referred to Bu Ali Sina hospital, for whom DMSA scan was performed. Results: Of 208 enrolled children, 83.2% were girls and 16.8% were boy with mean age of 32.80 ± 32.57 months. Based on the first DMSA scan, the prevalence of scars was about 40%; and based on second DMSA scan (delayed), the prevalence was about 34%. In people who had scar, the frequency of UTI was more. In these patients, the most common organisms were Escherichia coli (71.4%), Proteus (14.3%), and Klebsiella (10.7%). Proteus significantly led to scar formation more than the others. Vesicoureteral reflux (VUR) with prevalence of 67.9% was the most common observed disease; and all patients with severe scars suffered from VUR. Scar in DSMA scan had no significant relationship with age and gender. Conclusion: Scar is a relatively common complication of UTI in children and VUR is an important risk factor for permanent damage. It is mandatory to think to this critical complications in children with UTI. Keywords Urinary tract infection; Scar; DMS

Subcutaneous Injection of Allogeneic Adipose-Derived Mesenchymal Stromal Cells in Psoriasis Plaques: Clinical Trial Phase I

Objective: Mesenchymal stromal cells (MSCs) play immunomodulatory role in various autoimmune diseases. Previouspre-clinical and clinical studies have shown that MSCs could be a therapeutic modality for psoriasis. However, themechanisms of treatment and its possible side effects are under investigation. In this study, the safety and probableefficacy of injecting allogeneic adipose-derived mesenchymal stromal cells (ADSCs) in psoriatic patients were evaluated.Materials and Methods: In this phase I clinical study with six months of follow-up, total number of 1×106 or 3×106cells/cm2 of ADSCs were injected into the subcutaneous tissue of each plaque as a single dose in three males and twofemales (3M/2F) with a mean age of 32.8 ± 8.18. The primary outcome was safety. Changes in clinical and histologicalindexes, the number of B and T lymphocytes in local and peripheral blood, and serum levels of inflammatory cytokineswere assessed. Paired t test was used to compare variables at two time points (baseline and six months after injection)and repeated measures ANOVA test was utilized for variables at three time points in follow-up visits.Results: No major adverse effects such as burning, pain, itching, or any systemic side effects were observed followingADSCs injection, and the lesions showed slight to considerable improvement after injection. The mRNA expressionlevels of pro-inflammatory factors were reduced in the dermis of the patients after injection. The increased expressionlevel of Foxp3 transcription factor in the patient blood samples suggested modulation of inflammation after ADMSCsadministration. Six months after the intervention, no major side effects were reported, but skin thickness, erythema, andscaling of the plaques, as well as the PASI score, were decreased in majority of patients.Conclusion: Our study suggested that ADSC injection could be considered as a safe and effective therapeuticapproach for psoriatic plaques (registration number: IRCT20080728001031N24)

A Comparative Analysis of Clinical Characteristics and Laboratory Findings of COVID-19 between Intensive Care Unit and Non-Intensive Care Unit Pediatric Patients: A Multicenter, Retrospective, Observational Study from Iranian Network for Research in Viral

Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs). Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings. Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran. Results: Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9% vs. 1.9%, respectively; p<0.001). Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

Background: Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods: We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results: All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions: Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths