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

Frequency of Metabolic Syndrome in Patients with Chronic Obstructive Pulmonary Disease

Background and purpose: There are controversies on the relationship between metabolic syndrome and chronic obstructive pulmonary disease (COPD). The present study was done to determine the frequency of metabolic syndrome in male patients with COPD as well as the associated illnesses and the symptoms of the disease. Materials and methods: In a cross-sectional survey in Qazvin University of Medical Sciences, 2014, a total of 80 COPD men (33-87-year-old) were enrolled. For all patients, demographic characteristics were recorded, a spirometric examination was done, and metabolic syndrome indicators, systemic inflammation (CRP) levels, and CHARLSON index were measured. We used regression analysis, independent t-test, and ANOVA to analyze the data. Results: The rate of metabolic syndrome was 37.5% in COPD patients. Patients with metabolic syndrome had more severe COPD, higher use of inhaled steroids, and fewer Forced expiratory volume in the first second (FEV1) than those who did not have metabolic syndrome (P<0.05). Diabetes (P= 0.009) and cardiac disorders (P= 0.023) showed a significant association with metabolic syndrome. Among the components of the metabolic syndrome, waist circumference, hypertension, and CRP had a significant association with airway obstruction (P<0.05). Conclusion: The prevalence of metabolic syndrome was high in COPD patients. We also found an association between the airflow obstruction in more severe COPD stages and metabolic syndrome, hypertension, and waist circumference. Keywords: metabolic syndrome, chronic obstructive pulmonary disease, hypertension, waist circumferenc

Stereotactic Breast Core Needle Biopsy in a Tertiary Breast Center of Tehran University of Medical Sciences

Background: The purpose of this study was to evaluate the results of stereotactic breast core needle biopsy in a tertiary breast center of Tehran University of Medical Sciences. Methods: Patients who were candidates for mammography-guided stereotactic breast core biopsy from March 2011 to December 2013 were included in this study. Stereotactic biopsy was performed by a dedicated prone Hologic mammography unit employing an automatic biopsy device with a 14-gauge needle. Patients with malignant or premalignant biopsy results were followed up with surgical pathology reports and patients with benign core biopsy findings were followed up with mammograms. Results: Among the 150 patients who were included in the final analyses, 30 had malignant findings on stereotactic biopsy and 10 patients had a premalignant pathology result on stereotactic biopsy. The remaining 110 patients had benign results on histopathology; however, in 30 patients, wire localization and surgery of the same area were performed due to either discordant mammography-pathology findings or clinical suspicion of malignancy and in two of them, advancing pathologic grade was witnessed. A total of 80 patients with benign histopathologic results had follow-up mammograms and the follow-up period was between 12 months to 3 years. The sensitivity and specificity of stereotactic breast core biopsy in this study were 94% and 96%, respectively. Conclusions: Stereotactic breast core needle biopsy is an effective and safe method in evaluation of suspicious mammography-detected lesions but caution should be warranted when taking results into account, especially in mammography-pathology discordance and in patients with premalignant pathology reports

Nail disorder among patients on maintenance hemodialysis

Background/Objective: Chronic renal failure can lead to nail disorders. The aim of this study was to investigate nail disorders and laboratory data in patients on constant hemodialysis (HD) in a hospital in Qazvin, Iran. Methods: A case-controlled study was performed. End stage renal disease patients (n = 149) undergoing regular HD and 147 randomly selected individuals were examined for nail disorder. All participants were examined by two trained students and a single dermatologist. Specific investigations such as nail biopsy, potassium hydroxide mount, and fungal culture were done if necessary. Laboratory data were completed for HD patients. Demographic characteristics, the causes of end stage renal disease, and laboratory data were tested in a multivariate analysis. Results: In this study, 62 HD patients had at least one nail disorder, with leukonychia being the most common in both groups. Clinical onychomycosis, absent lunula and half and half nail were the other common findings in HD patients. Positive mycological culture was noted in four HD patients and in none of the control individuals. The mean duration of HD was a significant predictor associated with the positive clinical onychomycosis (p < 0.05). Although there was no significant correlation between nail disorders and hypertension or heart failure, multiple logistic regression analysis indicated that gender, age ≥ 65 years, and diabetes mellitus (DM) were associated with nail disorder. Conclusion: The prevalence of nail disorder in this study was correlated with age, DM, and gender. To decrease the prevalence of nail disorder, attention to duration of HD, age, male sex, and DM is very important

Frequency of Metabolic Syndrome in Patients with Chronic Obstructive Pulmonary Disease

Background and purpose: There are controversies on the relationship between metabolic syndrome and chronic obstructive pulmonary disease (COPD). The present study was done to determine the frequency of metabolic syndrome in male patients with COPD as well as the associated illnesses and the symptoms of the disease. Materials and methods: In a cross-sectional survey in Qazvin University of Medical Sciences, 2014, a total of 80 COPD men (33-87-year-old) were enrolled. For all patients, demographic characteristics were recorded, a spirometric examination was done, and metabolic syndrome indicators, systemic inflammation (CRP) levels, and CHARLSON index were measured. We used regression analysis, independent t-test, and ANOVA to analyze the data. Results: The rate of metabolic syndrome was 37.5% in COPD patients. Patients with metabolic syndrome had more severe COPD, higher use of inhaled steroids, and fewer Forced expiratory volume in the first second (FEV1) than those who did not have metabolic syndrome (P<0.05). Diabetes (P= 0.009) and cardiac disorders (P= 0.023) showed a significant association with metabolic syndrome. Among the components of the metabolic syndrome, waist circumference, hypertension, and CRP had a significant association with airway obstruction (P<0.05). Conclusion: The prevalence of metabolic syndrome was high in COPD patients. We also found an association between the airflow obstruction in more severe COPD stages and metabolic syndrome, hypertension, and waist circumference

Optimization and characterization of silver nanoparticle-modified luffa for the adsorption of ketoprofen and reactive yellow 15 from aqueous solutions

Abstract In the current work, luffa was modified with silver nanoparticles to prepare LF/AgNPs adsorbent for the elimination of ketoprofen and reactive yellow 15 (RY15) from aqueous media. Various characterization techniques, including FT-IR, XRD, BET, and SEM–EDS analysis, were employed to confirm the successful modification of LF/AgNPs. Several key parameters such as contact time, adsorbent dosage, concentration, pH, and agitation technique were fine-tuned to optimize the adsorption process. Ketoprofen removal was found to be most effective in weakly acidic conditions (pH = 5), while reactive yellow 15 adsorption was enhanced in an acidic environment (pH = 2). At 298 K, the highest adsorption capacities reached 56.88 mg/g for ketoprofen and 97.76 mg/g for reactive yellow 15. In both scenarios involving the elimination of ketoprofen and RY15, the Temkin isotherm exhibits higher R2 values, specifically 0.997 for ketoprofen and 0.963 for RY15, demonstrating a strong correlation with the observed adsorption data. Additionally, the kinetics of ketoprofen adsorption were best described by the Pseudo-first order model (R2 = 0.989), whereas the Pseudo-second order model provided the most accurate fit for reactive yellow 15 adsorption (R2 = 0.997). Importantly, the LF/AgNPs adsorbent displayed consistent performance over five consecutive reuse cycles, affirming its stability and efficacy in removing both contaminants. These findings underscore the exceptional potential of LF/AgNPs as a reliable adsorbent for the removal of reactive yellow 15 and ketoprofen from aqueous solutions

Przezczaszkowa stymulacja prądem stałym przy nieswoistym bólu dolnego odcinka kręgosłupa – randomizowane badanie z podwójnie ślepą próbą, z grupą kontrolną otrzymującą placebo

Introduction: Low back pain is recognized as a major cause of morbidity worldwide. Between 70 and 80% of adults experience at least one occasion of low back pain with duration of 3 months or longer in their lifetime. Aside from the classic treatment methods, there are other new techniques yet to be clinically investigated. Transcranial direct current stimulation (tDCS) has been reported to alleviate pain by affecting the central nervous system. To date only a small number of studies have been published on the effects of tDCS on chronic low back pain. Some of these were pilot studies and others were low-powered in terms of their inference. Therefore the clinical application of tDCS requires further careful evaluation. Objective: To assess the efficacy of transcranial direct current stimulation for treatment of chronic nonspecific low back pain. Materials and methods: We carried out a double-blind randomized sham-controlled trial in a University Hospital. In total 70 people (15 women) with low back pain were randomized to either active or sham stimulation. The primary outcome was intensity of low back pain on the Visual Analog Scale. We also used the Oswestry Disability Questionnaire to evaluate the effects of back pain on daily activities. For the active stimulation group we administered 2 mA tDCS, 20 minutes for each session, once daily, 5 days per week for 2 weeks, totaling 10 sessions. For the sham stimulation group a similar program was followed with no stimulation. Both groups used analgesic medication. Results: Within-group analysis showed that an initial decrease in pain intensity was significant in both groups (both p < 0.001). However, pain reduction became stable only in the active treatment group. There was a significant difference in the pattern of change in mean pain scores in favor of tDCS (p < 0.001). Active treatment also significantly reduced disability scores (all p values < 0.001), whereas participants in the sham treatment group did not experience functional recovery. Mixed ANOVA indicated that the pattern of change in mean scores of disability differed between the two groups throughout the study course, in favor of active stimulation (p < 0.001). Conclusion: Transcranial direct current stimulation is an effective and safe initial treatment for chronic nonspecific low back pain, and the benefits remain for at least several months.Wstęp: Na całym swiecie ból dolnego odcinka kręgosłupa j est uznawany za poważną przyczynę zachorowalności. Pomiędzy 70 a 80% dorosłych osób doświadcza co najmniej raz w życiu bólu dolnego odcinka kręgosłupa, utrzymujacego się 3 miesiące lub dłużej. Oprócz klasycznych metod leczenia, istnieją inne nowe techniki, które jeszcze należy sprawdzić klinicznie. Dowiedziono, że przezczaszkowa stymulacja prądem stałym (ang. transcranial direct current stimulation, tDCS) łagodzi ból poprzez oddziaływanie na centralny system nerwowy. Do tej pory, opublikowano tylko niewielką ilość badań na temat wpływu tDCS na przewlekły ból dolnego odcinka kręgosłupa. Niektóre z nich były badaniami pilotażowymi, a inne były słabe pod względem swoich wniosków. Dlatego też kliniczne zastosowanie tDCS, wymaga dalszej, starannej oceny. Cel: Określenie skuteczności przezczaszkowej stymulacji prądem w leczeniu przewlekłego niespecyficznego bólu dolnego odcinka kręgosłupa. Materiały i metody: Przeprowadziliśmy randomizowane badanie z podwójnie ślepą próbą, z grupą kontrolną otrzymującą placebo w Szpitalu Uniwersyteckim. W sumie 70 osób (15 kobiet) z bólem dolnego odcinka kręgosłupa, przydzielono losowo do grupy z aktywną stymulacją lub grupy z pozorowaną stymulacją. Głównym ocenianym parametrem była intensywność bólu dolnego odcinka kręgosłupa na Wizualnej Skali Analogowej (ang.the Visual Analog Scale). Zastosowaliśmy również kwestionariusz Oswestry (ang. the Oswestry Disability Questionnaire) do oceny wpływu bólu pleców na codzienne czynności. U grupy z aktywną stymulacją, zastosowaliśmy 2 mA tDCS, 20 minut na każdą sesję, raz dziennie, 5 dni w tygodniu, przez okres 2 tygodni, w sumie 10 sesji. U grupy z pozorną stymulacją, zastosowano podobny program, ale bez stymulacji. Obie grupy stosowały leki przeciwbólowe. Wyniki: Analiza wewnątrzgrupowa wykazała, że początkowy spadek intensywności bólu był znaczący w obu grupach (obie wartości p < 0.001). Jednak zmnieszony ból utrzymał się tylko w grupie z rzeczywistym leczeniem. Wystąpiła znacząca różnica we wzorze zmian w średnich wynikach na korzyść tDCS (p < 0.001). Aktywne leczenie również znacznie obniżyło wyniki niepełnosprawności (wszystkie wartości p < 0.001), podczas gdy uczestnicy z grupy z pozorowanym leczeniem, nie doświadczyli funkcjonalnego powrotu do zdrowia. Mieszana ANOVA wykazała, że wzór zmiany w średnich wynikach niepełnosprawności różnił się pomiędzy dwoma grupami podczas całego toku badania, na korzyść aktywnej stymulacji (p < 0.001). Wniosek: Przezczaszkowa stymulacja prądem stałym jest efektywnym i bezpiecznym początkowym leczeniem dla przewlekłego niespecyficznego bólu dolnego odcinka kręgosłupa, a jej efekty utrzymują się przez co najmniej kilka miesięcy

Primary Right Atrial Sarcoma Presenting with Cardiac Tamponade and Massive Pleural Effusion

Primary cardiac sarcomas are very rare and there is no consensus on management. Clinical presentation is usually late. Despite newer diagnostic technology, prognosis remains dismal. We report a case of right atrial sarcoma in a 28-year-old man who presented with acute cardiac tamponade. Emergency subxiphoid pericardial drainage stabilized the patient's critical condition. The lesion was advanced. Therefore, we only performed a suboptimal surgical resection. Despite planning for radiation, the patient's status deteriorated. Only palliative measures continued during the next four months before his death due to disseminated metastasis and progressive cardiopulmonary failure