Nutritional status in intensive care unit patients: a prospective clinical cohort pilot study

Previous researches have shown that the nutritional status of patients in the intensive care unit (ICU) was poor on admission and appears to decline during their stay in the ICU. Critically ill patients are prone to malnutrition because their hypermetabolic disorders lead to an increase in nutritional requirements that are not often met with the nutrition supplied. The aim of this study was to assess the nutritional status and hs-CRP of ICU patients on admission and discharge from the hospital. Twenty-nine neurological ICU patients (20–87 years old) underwent fasting blood sample collections, anthropometric measurements and impedance analysis on admission and discharge at Ghaem Teaching Hospital. NRS 2002 was used to determine malnutrition in ICU patients. Markers of nutritional status changed from admission into the ICU until discharge as follows: weight, BMI and triceps skinfold thickness decreased (p < 0.001, p < 0.001 and p < 0.005, respectively). hs-CRP was decreased over the stay in the hospital (admission = 19.4 ± 16.3, discharge = 13.8 ± 14.5, p value = 0.11). The percent of patients at risk of malnutrition decreased during stay in ICU (not significant). Prevalence of malnutrition was as high as 47.6% on admission. The nutritional status of patients was slightly improved over the period of their stay in hospital using NRS 2002 method.     

Oral manifestations of COVID‐19 disease: A review article

Dysgeusia is the first recognized oral symptom of novel coronavirus disease (COVID‐19). In this review article, we described oral lesions of COVID‐19 patients. We searched PubMed library and Google Scholar for published literature since December 2019 until September 2020. Finally, we selected 35 articles including case reports, case series and letters to editor. Oral manifestations included ulcer, erosion, bulla, vesicle, pustule, fissured or depapillated tongue, macule, papule, plaque, pigmentation, halitosis, whitish areas, hemorrhagic crust, necrosis, petechiae, swelling, erythema, and spontaneous bleeding. The most common sites of involvement in descending order were tongue (38%), labial mucosa (26%), and palate (22%). Suggested diagnoses of the lesions were aphthous stomatitis, herpetiform lesions, candidiasis, vasculitis, Kawasaki‐like, EM‐like, mucositis, drug eruption, necrotizing periodontal disease, angina bullosa‐like, angular cheilitis, atypical Sweet syndrome, and Melkerson‐Rosenthal syndrome. Oral lesions were symptomatic in 68% of the cases. Oral lesions were nearly equal in both genders (49% female and 51% male). Patients with older age and higher severity of COVID‐19 disease had more widespread and sever oral lesions. Lack of oral hygiene, opportunistic infections, stress, immunosuppression, vasculitis, and hyper‐inflammatory response secondary to COVID‐19 are the most important predisposing factors for onset of oral lesions in COVID‐19 patients.     

Are non-pylori helicobacters present in the human oral cavity?

Introduction and objective

Helicobacter pylori (H. pylori) is a human gastric pathogen. Because of presence of H. pylori oral cavity, there is a possibility of H. pylori transmission by oral-oral route. In a crosssectional study, the presence of some virulence factors of H. pylori and also non-pylori Helicobacters in dental plaque samples of participants was investigated.

Methods

The samples were collected from at least two teeth surfaces. DNA of the samples was extracted using specific kit. The presence of dupA (jhp0917 and jhp0918) and babA2 genes and also Helicobacter genus and H. pylori species was investigated using polymerase chain reaction by specific primers.

Results

In total 44% (20/45) and 86.7% (39/45) of samples was positive for ureC and 16SrRNA genes respectively. The frequency of babA2, jhp0917 and jhp0918 genes in H. pylori isolates were 40, 20 and 65% respectively. It seems 19 samples were positive probably non-pylori Helicobacters.

Conclusion

In the present study we report for the first time the presence of non-pylori Helicobacter species and also high frequency of babA2 and dupA genotypes in dental plaque samples.

     

Molecular characterization of nasal methicillin resistant Staphylococcus aureus isolates from workers of an automaker company in southeast Iran

Colonization of methicillin resistant Staphylococccus aureus (MRSA) can occur more commonly in healthy people who live in close together or are in close physical contact with each other. Having knowledge about the molecular characteristics of these strains provides considerable discernment into the epidemiology of this important microorganism. A total of 806 nasal swabs were collected from healthy workers of an automaker company in the southeast of Iran and were analyzed to detect MRSA isolates. Multilocus sequence typing (MLST), spa typing, and detection of staphylococcal cassette chromosome mec (SCCmec) were performed. The presence of genes encoding Panton‐Valentine Leukocidin (PVL) and Arginine Catabolic Mobile Element (ACME) were also investigated. Carriage rate of S. aureus was 20%. Among 10 identified MRSA, no acme was found while high prevalence of pvl (60%) was of great concern. Seven different spa types including five new ones were identified. The most frequent sequence type was the novel one; ST 3373 (n = 3), followed by each of ST22, ST88, ST859 (n = 2) and ST1955 (n = 1). MRSA isolates were clustered into two main clonal complexes; CC22 (n = 6) and CC88 (n = 4). Low genetic diversity with the dominance of CC22, SCCmecIV was found. Distribution of previously found hospital‐associated MRSA was demonstrated among our isolates.     

3D cerebral MR image segmentation using multiple-classifier system

The three soft brain tissues white matter (WM), gray matter (GM), and cerebral spinal fluid (CSF) identified in a magnetic resonance (MR) image via image segmentation techniques can aid in structural and functional brain analysis, brain’s anatomical structures measurement and visualization, neurodegenerative disorders diagnosis, and surgical planning and image-guided interventions, but only if obtained segmentation results are correct. This paper presents a multiple-classifier-based system for automatic brain tissue segmentation from cerebral MR images. The developed system categorizes each voxel of a given MR image as GM, WM, and CSF. The algorithm consists of preprocessing, feature extraction, and supervised classification steps. In the first step, intensity non-uniformity in a given MR image is corrected and then non-brain tissues such as skull, eyeballs, and skin are removed from the image. For each voxel, statistical features and non-statistical features were computed and used a feature vector representing the voxel. Three multilayer perceptron (MLP) neural networks trained using three different datasets were used as the base classifiers of the multiple-classifier system. The output of the base classifiers was fused using majority voting scheme. Evaluation of the proposed system was performed using Brainweb simulated MR images with different noise and intensity non-uniformity and internet brain segmentation repository (IBSR) real MR images. The quantitative assessment of the proposed method using Dice, Jaccard, and conformity coefficient metrics demonstrates improvement (around 5 % for CSF) in terms of accuracy as compared to single MLP classifier and the existing methods and tools such FSL-FAST and SPM. As accurately segmenting a MR image is of paramount importance for successfully promoting the clinical application of MR image segmentation techniques, the improvement obtained by using multiple-classifier-based system is encouraging.     

Concomitant intraventricular colloid cyst and low-grade astrocytoma of the brainstem in a 16-year-old boy

Multiple primary brain tumors are commonly observed in patients with a history of brain radiation therapy or neurofibromatosis. The concomitant presence of 2 different types of brain tumors in a single location or chamber is a very rare clinical presentation in the absence of such a predisposing factor. The authors report on the case of a 16-year-old boy presenting with different types of brain tumors in 2 ventricular chambers concomitantly. This boy had a medium-sized colloid cyst of the third ventricle and a large fibrillary astrocytoma fungating from the brainstem into the floor of the fourth ventricle. The lesions were successfully excised in 2 separate surgeries. Radiotherapy was used as the adjuvant mode of therapy. There has been no sign of tumor recurrence after 16 months of follow-up. Clinical awareness and recognition of such a combination of tumors is important because they will dictate special treatment strategies depending on the individual biological aggressiveness of each tumor.     

Distribution of Ebp pili among clinical and fecal isolates of Enterococcus faecalis and evaluation for human platelet activation

Although Enterococcus faecalis is known as normal flora in colon, it is also amongst the most common causative agents of infective endocarditis (IE). Platelet activation resulting from adherence to platelets is an essential step in the pathogenesis of IE. One of the factors proposed in adhesion is endocarditis‐ and biofilm‐ associated pili encoded by ebp operon. The aim of this study was to investigate ebp in isolates from different origins and analyze the potential of isolates to activate human platelets of different donors. The ebp distribution was investigated in E. faecalis from different origin infections (n = 103) and fecal flora (n = 20). Then, selected isolates from blood (n = 5), urine (n = 2), and fecal flora (n = 3) were analyzed by flow cytometry assay for the ability to activate platelets of four different donors. No statistically significant difference was found for the ebp presence between infective and fecal isolates. Also, it was found that the ability for platelet activation is independent of the bacterial origin. However, significant difference was found in platelet activation between different donors. The results suggest that the presence or absence of ebp is not a critical factor for platelet activation by E. faecalis isolates. However, host factors seem to contribute in this activity.