Worldwide prevalence of microbial agents’ coinfection among COVID‐19 patients: A comprehensive updated systematic review and meta‐analysis

BackgroundTo provide information about pathogens’ coinfection prevalence with SARS‐CoV‐2 could be a real help to save patients’ lives. This study aims to evaluate the pathogens’ coinfection prevalence among COVID‐19 patients.MethodIn order to find all of the relevant articles, we used systematic search approach. Research‐based databases including PubMed, Web of Science, Embase, and Scopus, without language restrictions, were searched to identify the relevant bacterial, fungal, and viral coinfections among COVID‐19 cases from December 1, 2019, to August 23, 2021. In order to dig deeper, other scientific repositories such as Medrxiv were probed.ResultsA total of 13,023 studies were found through systematic search. After thorough analysis, only 64 studies with 61,547 patients were included in the study. The most common causative agents of coinfection among COVID‐19 patients were bacteria (pooled prevalence: 20.97%; 95% CI: 15.95–26.46; I ²: 99.9%) and less frequent were virus coinfections (pooled prevalence: 12.58%; 95% CI: 7.31–18.96; I ²: 98.7%). The pooled prevalence of fungal coinfections was also 12.60% (95% CI: 7.84–17.36; I ²: 98.3%). Meta‐regression analysis showed that the age sample size and WHO geographic region did not influenced heterogeneity.ConclusionWe identified a high prevalence of pathogenic microorganism coinfection among COVID‐19 patients. Because of this rate of coinfection empirical use of antibacterial, antifungal, and antiviral treatment are advisable specifically at the early stage of COVID‐19 infection. We also suggest running simultaneously diagnostic tests to identify other microbiological agents’ coinfection with SARS‐CoV‐2.     

Percutaneous Excisional Biopsy of Palpable Breast Masses under Ultrasound Visualization

Abstract:   A palpable breast mass is a common reason for surgical consultation. Our goal was to determine whether ultrasound-guided vacuum-assisted core biopsy (US-VACB) is safe and effective in completely removing presumed benign palpable breast masses. We conducted a cohort study of 201 consecutive patients with presumed benign palpable masses who underwent removal with US-VACB. The main outcome measured was the successful removal of palpable masses. Palpable masses were successfully removed with US-VACB in 99% of cases; 2% were cancer and 7.5% were atypical ductal hyperplasia or phyllodes tumor. Two clinical recurrences representing a seroma were seen on follow-up. US-VACB is safe and effective in the initial diagnosis and management of presumed benign palpable breast masses. It provides the benefits of percutaneous biopsy and the palpable abnormality no longer remains.      

Huge Varicose Inferior Mesenteric Vein: an Unanticipated 99m Tc-labeled Red Blood Cell Scintigraphy Finding

Ectopic varices (EcV) are enlarged portosystemic venous collaterals, which usually develop secondary to portal hypertension (PHT). Mesocaval collateral vessels are unusual pathways to decompress the portal system. Here we report the case of a huge varicose inferior mesenteric vein (IMV) that drained into perirectal collateral veins, demonstrated by ^99mTc-labeled red blood cell (RBC) scintigraphy performed for lower gastrointestinal (GI) bleeding in a 14-year-old girl. This case illustrates the crucial role of ^99mTc-labeled RBC scintigraphy for the diagnosis of rare ectopic lower GI varices.     

A validation trial of subdermal injection compared with intraparenchymal injection for sentinel lymph node biopsy in breast cancer

Sentinel lymph node (SLN) biopsy is increasingly being used as an accurate and less morbid surrogate for axillary dissection. However, a standardized technique in the biopsy of SLNs is not used. Some authors propose subdermal injection to be as accurate as peritumoral intraparenchymal injection (IPI). Our objective is to determine whether the SLNs identified by subdermal injection truly represent SLNs and match those found with IPI. Specific end points of the study were 1) successful localization of the SLN by the IPI of isosulfan blue or the radiocolloid intradermal injection, 2) successful uptake of radiocolloid and isosulfan blue on individual SLN, and 3) determination of the frequency with which the radiocolloid injection detected the "gold standard" blue SLN. SLNs were found in 71 of 73 cases (success rate = 97%). Blue SLNs were identified in 64 patients (88%). SLNs in 61 patients (84%) were radioactive. A total of 112 SLNs were identified in 71 patients (1.6 nodes/patient). Seventy-six of 87 SLNs found with IPI were also radioactive (concordance of 87%). All SLNs harboring metastatic cancer (16 patients) were found by both techniques, being both blue and radioactive. Our results support the concept of shared lymphatic pathways in the breast with a high degree of communication between the subdermal lymphatics and the intraparenchymal lymphatics. The success in identification of the SLN is made simpler and improved by the addition of subdermal radiocolloid injection.     

Attenuation of morphine withdrawal signs by a D1 receptor agonist in the locus coeruleus of rats

In the present study, the effects of intra-locus coeruleus injection of a dopamine D(1) receptor agonist (SKF38393) on naloxone-induced withdrawal signs of morphine-dependent rats were examined. Twenty different withdrawal signs were assessed. The total withdrawal score was calculated and used as an index of withdrawal intensity for comparison. The D(1) agonist and antagonist were injected 15 and 30 min prior to expression of naloxone-induced withdrawal signs, respectively. SKF38393 (2 and 4 microg/site) decreased while SCH23390 (a D(1) antagonist) had no effect on the total withdrawal score. On the other hand, SCH23390 (25 ng/site) reversed the SKF38393 effect. It may be concluded that activation of dopamine D(1) receptors in the locus coeruleus attenuates naloxone-induced withdrawal.     

The relationship between lichen planus and hepatitis C in dermatology outpatients in Kerman, Iran

BACKGROUND: Lichen planus (LP) is classified as a papulosquamous disease. It has been associated with liver disease, particularly hepatitis C virus (HCV) infection, in several studies. Most of these reports, especially the larger series, were conducted in Europe and Japan. OBJECTIVE: We conducted a case-control study in Kerman, Iran to explore the association between LP and HCV. METHODS: The study included 66 patients with LP (as cases; mean age = 39.7 +/- 15.8 years; 31 female, 35 male) and 140 volunteer blood donors (as controls; mean age = 29.5 +/- 8.4 years; 43 females, 97 males). An enzyme-linked immunosorbent assay (ELISA) was used to determine the presence of anti-HCV antibodies in all subjects in both groups. To confirm positive diagnoses, a second generation recombinant immunoblot assay (RIBA II) test was performed. RESULTS: Lichen planus lesions were most frequently located on the trunk and extremities, and the most common clinical type was generalized LP (48.5%). One of the patients with LP (1.5%) and three of the controls (2.1%) were HCV-Ab positive. No significant difference was observed in HCV-Ab positive between the two groups (OR = 0.7; 95% CI = 0.1-6.9). CONCLUSION: The findings indicate that an investigation for HCV infection should not necessarily be performed in all patients with LP. It is recommended that further studies should focus on larger groups in other regions of Iran to determine whether testing for HCV infection is necessary in patients with LP.     

Concentrated pomegranate juice improves lipid profiles in diabetic patients with hyperlipidemia

This study assessed the effect of concentrated pomegranate juice (CPJ) consumption on lipid profiles of type II diabetic patients with hyperlipidemia (cholesterol >/= 5.2 mmol/L or triacylglycerol >/= 2.3 mmol/L). In this quasi-experimental study 22 otherwise healthy diabetic patients, 14 women (63.6%) and eight men (36.4%), were recruited from among patients referred to the Iranian Diabetes Society. The patients were followed for 8 weeks to establish a baseline for normal dietary intake before beginning the CPJ intervention. During the pre-study period a 24-hour food recall and food records (recording flavonoid-rich foods) were completed every 10 days. At the end of the eighth week, anthropometric and biochemical assessments were done. Thereafter the patients consumed 40 g/day of CPJ for 8 weeks, during which time dietary assessment was continued. After completing the study, anthropometric and blood indices were again evaluated. The Wilcoxon signed test was used for statistical analysis. A value of P <.05 was considered significant. Mean (+/-SD) age, weight, and duration of diabetes were 52.5 +/- 5.2 years, 71.5 +/- 10.3 kg, and 7.9 +/- 6.6 years, respectively. After consumption of CPJ, significant reductions were seen in total cholesterol (P <.006), low-density lipoprotein (LDL)-cholesterol (P <.006), LDL-cholesterol/high-density lipoprotein (HDL)-cholesterol (P <.001), and total cholesterol/HDL-cholesterol (P <.001). But, there were no significant changes in serum triacylglycerol and HDL-cholesterol concentrations. Anthropometric indices, physical activity, kind and doses of oral hypoglycemic agents, and the intakes of nutrients and flavonoid-rich foods showed no change during the CPJ consumption period. It is concluded that CPJ consumption may modify heart disease risk factors in hyperlipidemic patients, and its inclusion therefore in their diets may be beneficial.