Human Linguatulosis Caused by Linguatula serrata in the City of Kerman,South-eastern Iran- Case Report

Human linguatulosis poses an important medical and veterinary concern in endemic countries. Animals, as reservoir host, play a major role in transmission of infestation and epidemiology of the disease. This study reports a case of human linguatulosis caused by Linguatula serrata in the city of Kerman, South-eastern Iran. A woman suffering from upper respiratory symptoms is presented. The patient consumed raw liver of sheep who was admitted to the Afzalipour University Hospital in Kerman for the symptoms of upper respiratory tract. In microscopic examination of the nasopharyngeal discharge, L. serrata was detected. This report has future medical implication in precise diagnosis of L. serrata in patients with complaints of nasopharyngeal symptoms.     

Post‐COVID‐19 maxillary osteonecrosis and floating maxillary teeth due to mucormycosis in two uncontrolled diabetic patients

Mucormycosis is a rare, invasive, quickly progressing fungal infection that generally affects patients who are immunocompromised. If left untreated, the disease is characterized by progressive necrosis and is often fatal. We present two cases of post‐COVID‐19 mucormycosis with a history of several years of uncontrolled diabetic mellitus.     

Metabolism modulates network synchrony in the aging brain

Brain aging is associated with hypometabolism and global changes in functional connectivity. Using functional MRI (fMRI), we show that network synchrony, a collective property of brain activity, decreases with age. Applying quantitative methods from statistical physics, we provide a generative (Ising) model for these changes as a function of the average communication strength between brain regions. We find that older brains are closer to a critical point of this communication strength, in which even small changes in metabolism lead to abrupt changes in network synchrony. Finally, by experimentally modulating metabolic activity in younger adults, we show how metabolism alone—independent of other changes associated with aging—can provide a plausible candidate mechanism for marked reorganization of brain network topology.

One of the most fundamental questions in neuroscience is how the familiar patterns of collective, brain-wide activity arise from the properties of the constituent neurons and their networks. Here, we study how the brain’s global activity patterns change with age and how those changes might arise from the reduced metabolic activity of constituent regions.We draw on two types of experimental evidence. First, as established using positron emission tomography, older brains show reduced glucose metabolism (1–3). Second, as established by functional MRI (fMRI), aging is associated with weakened functional connectivity (FC; i.e., reduced communication [on average] between brain regions) (4–6). Combining both observations suggests that impaired glucose metabolism may underlie changes in FC (1, 7). Supporting this link are studies showing disruptions similar to those seen with aging in type 2 diabetic subjects (8, 9).In healthy brains, resting-state brain activity (states during which subjects are not engaged in any explicit task) alternates between segregating computations within localized functional domains and integrating this information across these domains (7, 10–13). The metabolic cost of these activities increases in proportion to the number and length of functional connections between pairs of brain regions (14), making highly connected (integrated) networks more energetically costly (10). Moreover, connections with the highest cost are the first to weaken with age (6, 7, 15, 16). Thus, it has been hypothesized that declining glucose metabolism in older brains drives the loss of high-cost (integrated) functional activities (14, 16). Yet, the relationship between energetic constraints at the level of individual regions and the apparent reorganization of the functional connectome is still not well understood.Statistical physics, which interprets the collective properties of complex systems in terms of individual interactions between the underlying parts, provides powerful tools for understanding how brain networks reorganize under constraints (17, 18). In particular, we employ an Ising model (19–21) to describe how pairwise interactions between brain regions give rise to specific profiles of network synchrony, a time-dependent average of the activity over the brain (22–24). The Ising model is a simple yet powerful tool to capture ordered and disordered phases and the transitions between them. It assumes that two things matter in understanding the collective behaviors of a system of agents (brain regions in this case): the topological relationships among the agents and their strength of interaction. This perspective can provide insight into global changes in FC observed in the data by assuming that brain regions are fully connected with a single average interaction strength.While the Ising model provides a general tool for describing the collective properties of complex systems, we adapt it to examine the specific relationship between brain aging and metabolic activity. To achieve this, we analyzed four resting-state fMRI datasets. We utilized two large-scale resting-state 3T (Tesla) fMRI datasets to identify aging related effects: the Cambridge Centre for Aging and Neuroscience Stage II Study (Cam-CAN; ages 18 to 88, N=652) (25) and the Human Connectome Project Aging fMRI dataset (HCP-A; ages 36 to 100, N=712) (26). To assess metabolic effects, we used two 7T fMRI datasets from the Protecting the Aging Brain fMRI data repository: a Bolus dataset (PAgB Bolus; ages 21 to 48, N=38) consisting of a within-subject experiment in which individuals were scanned following separate administration of calorie-matched glucose and ketones (d-β-hydroxybutyrate ketone ester [D-βHb]) and a Diet dataset (PAgB Diet; ages 21 to 43, N=12) consisting of an independent within-subject experiment of healthy, young adults scanned at resting state while on glycolytic and ketogenic diets (27). Ketone bodies decrease the relative free energy of adenosine triphosphate (ATP) production by approximately 27% as compared with glucose (28). The additional efficiency of ketone bodies as a cellular fuel source, observed even in healthy subjects, has been shown to increase both cardiac efficiency (28) as well as brain activity (27).The significance of this work is threefold. First, we demonstrate that the Ising model, with a fully connected topology, provides a mechanism for how FC patterns change in qualitatively abrupt ways as a function of the average interaction between brain regions (18). Second, we establish a direct link between network synchrony and the relative frequencies of integrated (high-cost) and segregated (low-cost) brain activities (10, 14). Finally, we suggest a precise relationship between differences in FC over the life span as well as in response to changes in the brain’s access to energy.     

Development of a bariatric surgery specific risk assessment tool for perioperative myocardial infarction

BackgroundPerioperative myocardial infarction (PMI) is a feared complication after surgery. Bariatric surgery, due to its intraabdominal nature, is traditionally considered an intermediate risk procedure. However, there are limited data on MI rates and its predictors in patients undergoing bariatric surgery.ObjectivesTo enumerate the prevalence of PMI after bariatric surgery and develop a risk assessment tool.SettingBariatric surgery centers, United States.MethodsPatients undergoing bariatric surgery were identified from the MBSAQIP participant use file (PUF) 2016. Preoperative characteristics, which correlated with PMI were identified by multivariable regression analysis. PUF 2015 was used to validate the scoring tool developed from PUF 2016.ResultsWe identified 172,017 patients from PUF 2016. Event rate for MI within 30 days of the operation was .03%; with a mortality rate of 17.3% in patients with a PMI. Four variables correlated with PMI on regression, including history of a previous MI (odds ratio [OR] = 8.57, confidence interval [CI] = 3.4–21.0), preoperative renal insufficiency (OR = 3.83, CI = 1.2–11.4), hyperlipidemia (OR = 2.60, CI = 1.3–5.1), and age >50 (OR = 2.15, CI = 1.1–4.2). Each predicting variable was assigned a score and event rate for MI was assessed with increasing risk score in PUF 2015; the rate increased from 9.5 per 100,000 operations with a score of 0 to 3.2 per 100 with a score of 5.ConclusionThe prevalence of MI after bariatric surgery is lower than other intraabdominal surgeries. However, mortality with PMI is high. This scoring tool can be used by bariatric surgeons to identify patients who will benefit from focused perioperative cardiac workup.     

Comparison of ergonomic risk assessment outputs from rapid entire body assessment and quick exposure check in an engine oil company

Background: During the last decades, to assess the risk factors of work-related musculoskeletal disorders (WMSDs), enormous observational methods have been developed. Rapid Entire Body Assessment (REBA) and Quick Exposure Check (QEC) are two general methods in this field. This study aimed to compare ergonomic risk assessment outputs from QEC and REBA in terms of agreement in distribution of postural loading scores based on analysis of working postures. Methods: This cross-sectional study was conducted in an engine oil company in which 40 jobs were studied. All jobs were observed by a trained occupational health practitioner. Job information was collected to ensure the completion of ergonomic risk assessment tools, including QEC, and REBA. Results: The result revealed that there was a significant correlation between final scores (r=0.731) and the action levels (r =0.893) of two applied methods. Comparison between the action levels and final scores of two methods showed that there was no significant difference among working departments. Most of studied postures acquired low and moderate risk level in QEC assessment (low risk=20%, moderate risk=50% and High risk=30%) and in REBA assessment (low risk=15%, moderate risk=60% and high risk=25%). Conclusion: There is a significant correlation between two methods. They have a strong correlation in identifying risky jobs, and determining the potential risk for incidence of WMSDs. Therefore, there is possibility for researchers to apply interchangeably both methods, for postural risk assessment in appropriate working environments.     

Keystone design perforator island flap for closure of myelomeningocele

Object  

We present a series of three infants who underwent keystone design perforator island flap (KDPIF) closure for myelomeningocele in a paediatric neurosurgical centre in Australia. This is the first recorded utilization of this flap for primary closure of myelomeningocele (MMC).     

Bacterial contamination rate of eyedrops: comparison of a hospital and a private outpatient center in Kermanshah, Iran

Bacterial contamination rate of eyedrops: comparison of a hospital and private outpatient ophthalmology centers of Kermanshah, Iran. Eye drops are sterile solutions with different clinical effects. Like any therapeutic medication, they should be administered using aseptic technique and stored in a way that prevents bacterial contamination. In our hospital and local private clinical settings, some cases of bacterial keratitis are thought to be due to eyedrops, which are used on multiple patients and at some point become contaminated. This study was done to compare the bacterial contamination rate in an educational hospital with private ophthalmic centers and attempt to identify the route of contamination and consequently, a method to resolve or reduce the problem.     

Treatment of Na(v)1.7-mediated pain in inherited erythromelalgia using a novel sodium channel blocker

Mutations in the SCN9A gene leading to deficiency of its protein product, Na_v1.7, cause congenital indifference to pain (CIP). CIP is characterized by the absence of the ability to sense pain associated with noxious stimuli. In contrast, the opposite phenotype to CIP, inherited erythromelalgia (IEM), is a disorder of spontaneous pain caused by missense mutations resulting in gain-of-function in Na_v1.7 that promote neuronal hyperexcitability. The primary aim of this study was to demonstrate that Na_v1.7 antagonism could alleviate the pain of IEM, thereby demonstrating the utility of this opposite phenotype model as a tool for rapid proof-of-concept for novel analgesics. An exploratory, randomized, double-blind, 2-period crossover study was conducted in 4 SCN9A mutation-proven IEM patients. In each treatment period (2 days), separated by a 2-day washout period, patients were orally administered XEN402 (400 mg twice daily) or matching placebo. In 3 patients, pain was induced by heat or exercise during each treatment arm. A fourth patient, in constant severe pain, required no induction. Patient-reported outcomes of pain intensity and/or relief were recorded, and the time taken to induce pain was measured. The ability to induce pain in IEM patients was significantly attenuated by XEN402 compared with placebo. XEN402 increased the time to maximal pain induction and significantly reduced the amount of pain (42% less) after induction (P = .014). This pilot study showed that XEN402 blocks Na_v1.7-mediated pain associated with IEM, thereby demonstrating target engagement in humans and underscoring the use of rare genetic disorders with mutant target channels as a novel approach to rapid proof-of-concept.     

Systematic Review of Hospital Based Cancer Registries (HBCRs): Necessary Tool to Improve Quality of Care in Cancer Patients

Introduction: Incidence and mortality rate of cancer is increasing in all countries including low and middle-income countries. Hospital based cancer registry (HBCR) is an important tool for administration purpose and improvement of the quality of care. It is also important resource for population based cancer registries. In this study we reviewed HBCRs in different countries. Methods: We searched the published literature using the MEDLINE (PubMed), Google scholar, Scopus, ProQuest and Google. We also reviewed websites of the HBCRs in different countries. The search was carried out based on proper keywords in English for all motor engines including "hospital-based", "clinical" and "data quality" combined with "registry", "cancer" and "tumor" including all subheadings. We reviewed objectives, developer institutions, minimum datasets, data sources, quality control indicators and processes. Results: In total we found 163 papers in the first step. After screening of the titles, abstracts and the full texts, 14 papers remained for analysis. Analysis of the 14 papers showed that the improvement of the quality of the care were the most important objectives among the registries. HBCRs collect information about patients, tumor diagnosis, treatment and follow-up. Generally, indicators such as completeness and validity were used for quality control. Conclusion: Because of the increases in cancer burden in the world, more attention is needed to be paid on cancer surveillance systems, including HBCRs. We evaluated and highlighted the importance and characteristics HBCRs and believe that this paper would help the hospitals and policy makers for planning and establishment of new HBCRs. We suggest the establishment of a worldwide network for coordination and collaboration between HBCRs.