bluuebunny/crossref_metadata_2025 huggingface dataset:
COVID-2019 Pneumonia
Authors: Al Umairi Rashid S. , Al Salmi Ishaq , Al Kalbani Jokha , Kamona Atheel , Al Tai Saqar , Al Kindi Faiza , Jose Sachin , Khamis Faryal , Al Khalili Huda , Al Busaidi Mohammed
Published: April 2021

Objectives: This study aimed to assess the correlation between the severity of the initial chest x-ray (CXR) abnormalities in patients with a confirmed diagnosis of COVID-19 and the final outcomes. Methods: This retrospective study was conducted at the Royal Hospital, Oman between mid-March and May 2020 and included patients who had been admitted with a confirmed diagnosis of COVID-19 and had a final outcome. Serial CXRs were identified and examined for presence, extent, distribution and progression pattern of radiological abnormalities. Each lung field was divided into three zones on each CXR and a score was allocated for each zone (0 is normal and 1–4 is mild–severe). The scores for all six zones per CXR examination were summed to provide a cumulative chest radiographic score (range: 0–24). Results: A total of 64 patients were included; the majority were male (89.1%) and the mean age was 50.22 ± 14.86 years. The initial CXR was abnormal in 60 patients (93.8%). The most common finding was ground glass opacity (n = 58, 96.7%) followed by consolidation (n = 50, 83.3%). Most patients had bilateral (n = 51, 85.0%), multifocal (n = 57, 95.0%) and mixed central and peripheral (n = 36, 60.0%) lung abnormalities. The median score of initial CXR for deceased patients was significantly higher than recovered patients (17 versus 11; P = 0.009). Five CXR evolution patterns were identified: type I (initial radiograph deteriorates then improves), type II (fluctuate), type III (static), type IV (progressive deterioration) and type V (progressive improvement). Conclusion: A higher baseline CXR score is associated with higher mortality rate and poor prognosis in those with COVID-19 pneumonia.
Keywords: SARS-CoV-2; COVID-19; X-ray Film; Pneumonia; Prognosis; Oman.
Clinical Profile of Stroke Patients Presenting to the Emergency Department of a Major Stroke Centre in Oman
Authors: Al Harthi Hasina A. , Al Kashmiri Ammar , Zakaryia Lubna M. , Al-Lawati Jawad A. , Najem Omar M. , Al-Lawati Isra , Memon Ghulam R. , Elfaham Amr A.
Published: April 2021

Objectives: Stroke is a significant public health problem and one of the most important preventable non-communicable diseases. Preventive stroke programmes with a better focus on increasing awareness among those who are currently at risk are yet to be properly established in Oman. This study was conducted to describe the characteristics of stroke patients presenting to a tertiary care hospital in Oman. Methods: This cross-sectional hospital-based study included 193 stroke cases which were prospectively recruited from the Emergency Department of Khoula Hospital, Muscat, Oman. Data were collected from November 2017 to April 2018. Results: The total number of patients was 193 with 82.9% of strokes being ischaemic strokes. Of this, 58% were male. The mean age of stroke patients was 61.05 years. Risk factors included hypertension (72.5%) and diabetes mellitus (54.4%). Dyslipidaemia, atrial fibrillation and ischaemic heart diseases were not particularly prevalent in the studied population and 24.4% of ischaemic strokes had large artery atherosclerosis while 21.9% had small vessel occlusion. Significantly more patients had lower Glasgow Coma Scale scores, required intensive care unit admission and experienced in-hospital deaths due to haemorrhagic stroke compared to ischaemic stroke. Conclusion: This study provides essential data regarding stroke characteristics specific to Oman’s population. Most of the information obtained appears to be in-line with what has been described internationally and, hence, preventive strategies similar to those indicated in extant literature can be implemented. This information can be utilised by health administrators in planning resource allocation. Further research is needed to explore rehabilitation aspects and long-term outcomes.
Keywords: Stroke; Ischemic Stroke; Haemorrhagic Stroke; Risk Factors; Thrombolytic Therapy; Epidemiology; Oman.
Severe Pneumonitis in Omani Infants During An In-Hospital Measles Outbreak
Authors: Al-Hashmi Samiya , Al-Mukhaini Kholoud , Shaikh Samiuddin , ElKhamisy Ahmad , Al Tahir Nuha , Al Maskari Nawal
Published: April 2021

Measles is a highly contagious infectious disease. Despite aggressive national initiatives to eradicate measles, outbreaks have occurred in recent years. We report three infants who presented to a tertiary care hospital in Muscat, Oman, in 2019 with measles and then developed pneumonitis, received intensive care treatment and made full recoveries. Infants can have an atypical presentation and develop severe symptoms. Pneumonitis is a serious complication and the management strategies are controversial. The early detection of measles and isolation of affected individuals play major roles in the elimination of measles outbreaks.
Keywords: Measles; Pneumonitis; Infant; Respiratory Distress Syndrome; Vitamin; Case Report; Oman.
Predictors of Nicotine Dependence among Adult Male Midwakh and Cigarette Smokers
Authors: Al Sharbatti Shatah , Shaikh Rizwana B. , Sreedharan Jayadevan , Muttappallymyalil Jayakumary , Weizman Michael
Published: April 2021

Objectives: Midwakh is a popular form of smoking in the Middle East. This study aimed to assess predictors of nicotine dependence among exclusive cigarette and midwakh smokers in the United Arab Emirates (UAE). Methods: This cross-sectional study was conducted from September to December 2015 in Ajman, UAE. A convenience sampling strategy was used to recruit adult male smokers aged ≥18 years who exclusively smoked either cigarettes or midwakh. A validated self-administered questionnaire was used to collect data from the participants, with nicotine dependence assessed using the Modified Fagerström Test for Nicotine Dependence. In addition, testing was performed to determine levels of salivary cotinine and exhaled breath carbon monoxide (CO). Results: A total of 88 adult male smokers were included in the study, of which 40 (45.5%) were cigarette smokers and 48 (54.5%) smoked midwakh. Most participants were 26–35 years of age (48.9%), followed by 18–25 years (30.7%) and ≥35 years (20.5%). Use of midwakh was associated with a more than three-fold increase in the risk of moderate to high nicotine dependence in comparison with cigarette smoking. Moreover, for each unit increase in CO level, there was a 10% increase in the risk of nicotine dependency. There was also a significant association between nicotine dependence level and depth of inhalation (P = 0.023).  Conclusion: Type of smoking and CO levels were found to be significant predictors of nicotine dependence among adult male smokers. In particular, greater dependency was observed among midwakh smokers compared to those who smoked cigarettes.

Keywords: Tobacco Use; Cigarette Smoking; Addictive Behaviors; Nicotine; Risk Assessment; Carbon Monoxide; Cotinine; United Arab Emirates.
Depression in Urban Omani Adults with Type 2 Diabetes
Authors: Alsumry Sanaa H , Al Ghelani Tharaya , Jaju Sanjay
Published: April 2021

Objectives: This study aimed to identify the prevalence of clinically significant depression among adult Omani patients with type 2 diabetes mellitus (T2DM) and explore potential associations with sociodemographic and clinical variables in this population. Methods: This descriptive cross-sectional study was conducted between August 2018 and September 2019 and included 427 Omani T2DM patients from 12 randomly selected government health centres in Muscat, Oman. An Arabic version of the validated Patient Health Questionnaire-9 was administered to the participants via face-to-face interviews to determine the prevalence of depression. Results: A total of 111 T2DM patients (response rate: 100%) had depression (26%). The presence of a personal history of depression was the only variable significantly associated with depression (P <0.001). Other sociodemographic and clinical factors including age, gender, duration of diabetes, glycated haemoglobin level, mode of diabetes treatment or the presence of diabetes-related complications such as cardiac complications, renal impairment, retinopathy, neuropathy and erectile dysfunction, were not associated with depression, (P >0.050 each). Conclusion: This study revealed a high prevalence of depression among urban Omani adults with T2DM and a personal history of depression, which was found to be significantly associated with depression. Therefore, early screening for depressive symptoms is necessary to improve the quality of life of diabetic patients in this region.
Keywords: Depression; Type 2 Diabetes Mellitus; Prevalence; Public Health; Primary Healthcare; Oman.
Is There Any Sympathetic Skin Response (SSR) Abnormality in Raynaud Phenomenon?
Authors: Emad Mohammad R. , Farpour Hamid R. , Ahmed Faisal , Tayebi Masoumeh , Nazarinia Mohammadali , Askarpour Mohammad R. , Nikbakht Hossein-Ali
Published: April 2021

Objectives: Sympathetic skin response (SSR) is a technique for assessment of the damage of peripheral neuropathies and the disorders of the sympathetic system. This study aimed to evaluate SSR among patients with Raynaud phenomenon (RP). Methods: Between January 1, 2015 and December 30, 2018, about 20 patients with RP and 20 healthy subjects as the control group were recruited from patients referring to the Outpatient Clinics of Shiraz medical University. All the participants were clinically examined, and the SSR was performed using a standard protocol. SSR is abnormal when the latency is prolonged and/or the amplitude reduced. Results: Raynaud's group consisted of 19 women (95 %) and 1 male (5%). 3 patients (15 %) with primary Raynaud's phenomenon (PRP) and 17 patients (85%) with secondary Raynaud's phenomenon (SRP). The control group consisted of 16 women (80%) and 4 males (20%). The mean age of the Raynaud's group and control subjects was 43.1±9 and 36.7±8.6 years, respectively. The SSR to the electrical stimulus was absent in 3 patients (PRP patients). The total median nerve mean latencies in the upper limb were 1.9±0.57 and 1.19±0.52 seconds for the Raynaud's group and control groups, respectively (p <0.001). These findings revealed significantly prolonged SSR latencies in the Raynaud's group, while the mean amplitude showed no significant differences in both groups (p =0.756). Conclusion: Absence or prolonged latency of SSR was associated with the disorders of the unmyelinated axons in the sympathetic system. Our findings suggested the disorders of unmyelinated axons in Raynaud's phenomenon.

Keywords: Raynaud Disease; Autonomic Nervous System; Electrodiagnosis; Sympathetic Fibers; Nerve Conduction.
Psychosocial Impact of COVID-19 on Healthcare Workers
Authors: Ali Syed M , Nausheen Sidrah
Published: April 2021

Objectives: This study aimed to assess the anxiety and depression symptoms in healthcare professionals in Pakistan as a result of the coronavirus pandemic. Methods: This cross-sectional study was conducted from May to June 2020 and included six different hospitals in Pakistan. An English-language demographics questionnaire, a validated COVID-19 fear scale, depression scale PHQ-9 and anxiety scale GAD-7 were sent to doctors, nurses and paramedical staff via WhatsApp. Data were analysed using descriptive statistics, Chi-square test and Student’s t-test. Results: A total of 400 participants were included in this study (response rate: 80.0%); 263 (65.8%) were doctors and 137 (34.3%) were nurses and paramedical staff. Of the participants, 57.0% were less than 40 years old and 18.3% were aged above 50. Most of the participants (n = 262; 65.5 %) experienced moderate levels of fear and 16.5% (n = 66) experienced a high level of fear. Moreover, 19.5% feared death and 56.5% reported social media to be responsible for increasing their fears. On the depression PHQ-9 and anxiety GAD-7 scales, 21.8% (n = 87) reported moderate to severe depression and anxiety symptoms. A significant relationship was demonstrated between the depression level and age, education and profession (P <0.001 each). Similarly, anxiety and depression scores were strongly related to the availability of personal protective equipment (P <0.001). Conclusion: It was found that 21.8% of healthcare professionals are suffering from moderate to severe depression symptoms, 15.5% had moderate to severe anxiety, whereas 65.5% had moderate symptoms of fear. The predictors are age, education level and co-morbidities. These moderate to high levels of fear and anxiety and depression raise concerns about the psychological well-being of healthcare staff and should be addressed through different programmes.
Keywords: COVID-19; Healthcare workers; Fear; Anxiety; Depression; Patient Health Questionnaire; Pakistan.
Abdominoscrotal Haematocele in an Adult and Its Successful Treatment
Authors: Kumbhar Uday S , Shaikh Oseen , Bhattarai Sandeep
Published: April 2021

Abdominoscrotal hydrocele (ASH) is a variant of hydrocele that rarely occurs in adults. ASH has two sacs, one in the scrotum and one in the abdomen connected through the inguinal canal. Abdominoscrotal haematocele is a rare complication of ASH. We report a 57-year-old male patient who presented to a tertiary care hospital in Puducherry, India, in 2019 with complaints of swelling in the scrotum for 15 years and abdominal pain for two months. Both the swellings were soft and cross fluctuation was present. Imaging confirmed the diagnosis of ASH. During a diagnostic laparoscopy, the abdominal sac was decompressed and found to have thick brownish fluid suggestive of haematocele. It was demonstrated that both sacs were connected. Due to difficulty in the dissection of the sac, the procedure was converted to an open procedure. Both the sacs were excised and Lytle’s repair was done for the dilated internal ring. The patient recovered and no recurrence of any swelling in the abdomen or scrotum was found at the end of a one-year follow-up.
Keywords: Testicular Hydrocele; Scrotal Hydrocele; Testicular Haematocele; Scrotal Haematocele; Laparoscopic Surgical Procedure; Laparoscopic Surgery; Case Report; India.
Delays in Presentation by Patients with ST Elevation Myocardial Infarction
Authors: Almashari Suhaib , Al-Malki Yasir , Al-Riyami Adil , Nadar Sunil K.
Published: April 2021

Objectives: To assess causes of delay for presentation with ST elevation myocardial infarction(STEMI) at our institution. Methods: We included patients with a STEMI that were taken up for primary angioplasty, who had presented from Jan 2017 to December 2019 to the emergency department at Sultan Qaboos university hospital, Muscat. Results:  101 patients (Mean age 54.8+10.8 years; 80 (79.2%) male) were included. The median (IQR) pain to door time was 60 (30-120) minutes.  66 (66%) patients arrived within 90 minutes. All except one arrived by privately arranged transport. Feeling that the pain was not important (60%) or not cardiac (22%) were the main reasons for delay. Being diabetic was the only patient factor that predicted delay. Conclusion: A high proportion of patients presenting to our institution with a STEMI arrived within recommended times. However more public education is required to improve awareness about the importance of early evaluation of chest pain.

Keywords: Acute myocardial infarction; prehospital delay.
Pulmonary Complications of COVID-19
Authors: Chan Wai Y , Hamid Marlina T Ramli , Lim Yi T , Ng Ching C , Gowdh Nadia FM , Rahmat Kartini
Published: April 2021

Rapid evolution of pulmonary complications associated with severe COVID-19 pneumonia often pose a management challenge to clinicians especially in the critical care setting. Serial chest imaging enable clinicians to better monitor disease progression and identify potential complications early which may decrease the mortality and morbidity associated with COVID-19. We report a 69-year-old male patient with severe COVID-19 pneumonia who presented to a tertiary referral centre in Kuala Lumpur, Malaysia, in 2020 with multiple pulmonary complications including lung cavitation, bronchopleural fistula, pneumothorax, pneumomediastinum, subcutaneous emphysema and acute pulmonary embolism. Unfortunately, the patient died one month after admission. COVID-19 patients may develop pulmonary complications due to a combination of direct viral lung damage, hypoxaemia and high stress ventilation. Awareness of COVID-19 complications can prompt early diagnosis and timely management to reduce morbidity and mortality.
Keywords: COVID-19; Lung; Fistula; Pneumothorax; Pneumomediastinum; Case Report; Malaysia.
Maintaining Weight and Nutritional Status with Ninjinyoueito in Elderly Patients with Chronic Wasting Diseases
Authors: Nakagawa Yumi , Kagohashi Katsunori , Shioya Ayako , Kinoshita Kensuke , Tsuji Hiroshi , Satoh Hiroaki
Published: April 2021

Objectives: To obtain information on the nutritional maintenance effects of Ninjinyoueito (NYT) in elderly patients with chronic wasting disease, a retrospective study was conducted. Methods: we investigated changes in bodyweight and serum levels of total protein and albumin in patients who received NYT for more than 6 months for chronic wasting diseases in our hospital from April 2009 and October 2019. Results: During the study period, 11 patients (median age: 75 years) had NYT for 6 months or more. The median administration period of NYT was 14 months. The bodyweight, serum total protein, and albumin at the time of last observation were not statistically different from those at the time of the start of NYT administration (p=0.1755, p=0.7659, p=0.5498, respectively). Conclusions: Our study suggested the possibility of maintaining nutritional condition by NYT in elderly patients with chronic wasting disease of various etiologies. More evidence will be required to confirm our results.

Keywords: body weight; nutritional status; ninjinyoueito; elderly patients; chronic wasting diseases
Mediastinal hydatidosis with an unusual presentation
Authors: Dantis Klein , Gupta Nilesh
Published: April 2021

Hydatidosis is a common zoonotic disease with high prevalence in developing countries. While solitary cyst with unilateral lung involvement is common, bilateral involvement and multiple cysts are rare, seen in 20% and 30% of the cases. Likewise, extensive involvement of extrapulmonary tissues and mediastinum is rare. We report an unusual case of mediastinal hydatidosis mimicking an intrathoracic malignancy in a 24-year-old female. She presented with a history of left-sided chest pain and heaviness in the left hemithorax for a period of two months. Diffuse, multiple fluid-filled cystic lesion with internal echoes throughout the mediastinum, lung, pericardium, diaphragm and chestwall were observed in contrast-enhanced computed tomography of the thorax. An incidental cystic lesion in liver was noted. Since serology for echinococcosis was negative, a differential diagnosis of intrathoracic malignancy was considered. However, intraoperative and histopathologic findings were suggestive of hydatidosis.

Keywords: Hydatid cyst; intrathoracic malignancy; computed tomography; magnetic resonance imaging; mediastinum
Antibiotics susceptibility of Escherichia coli isolates from clinical specimens before and during COVID-19 pandemic
Authors: Hagni Wardoyo Eustachius , Suardana I Wayan , Sutirta Yasa I Wayan Putu , Sukrama I Dewa Made
Published: April 2021

Background and Objectives: Escherichia coli is a Gram-negative organism causing mild to severe infections, with a wide spectrum range of organs involved. The study aimed to describe antibiotics susceptibility of E. coli from clinical specimens from October 11, 2019 to September 11, 2020.
Materials and Methods: Study was conducted retrospectively in a private microbiology laboratory in Mataram Indonesia. Period of study divided as two groups after WHO declared COVID-19 as pandemic by March 11, 2020; group A including the specimen related to September 2019 to March 11 th 2020 and group B including the specimens related to March 11 th 2020 to September 2020. All clinical specimens were subjected to identify E. coli isolates and their antibiotics susceptibility using WHO-NET 5.6 version.
Results: Totally, 148 E. coli isolates were found in group A and 62 isolates in group B. Prevalence of extended-spectrum beta lactamase (ESBL)- producing E. coli in group A was 50% and in group B was 20.9% with significantly difference (p<0.05). There was an increase in susceptibility to 10/16 antibiotics; where 3 antibiotics ofloxacin, aztreonam, and fosfomycin were significant (p<0.05). There was a significant decrease in susceptibility to the antibiotics piperacillin (p=0.012), amoxicillin (p=0.002), cefadroxil (p=0.036) and ampicillin (p=0.036). Type of infections between two groups: musculoskeletal infections, pneumonia, urinary tract infections and sepsis were not significant.
Conclusion: Reduced number of E. coli isolates between two groups with decrease of ESBL-producing E. coli contribute in dynamics of antibiotics susceptibility. The longer period of analysis is needed to be done, due to the ongoing COVID-19 pandemic.
Risk factors, bacteriological profile and outcome of surgical site infections following orthopaedic surgery
Authors: Suranigi Shishir Murugharaj , Ramya SR , Devi C Sheela , Kanungo Reba , Najimudeen Syed
Published: April 2021

Background and Objectives: Surgical site infection (SSI) is a challenge for the surgeon. Incidence of SSI reported in literature varies from 0.5% to 15%. Severity of SSI ranges from superficial skin infection to life-threatening condition like septicaemia. It is responsible for increased morbidity, mortality, and economic burden to the hospital in general, and the patient in particular. The aim of this study was to assess the risk factors, bacteriological profile, length of hospitalization, and cost due to orthopaedic SSI in patients admitted to a tertiary care hospital.
Materials and Methods: This was a prospective case control study. Cases were diagnosed based on CDC definition of nosocomial SSI. All cases were assessed preoperatively, intraoperatively and postoperatively, according to type of surgery, wound class, duration of operation, antimicrobial prophylaxis, use of drain, preoperative hospital stay, causative micro organism, total hospital stay, re-admission rates and cost incurred. Age, sex and surgical procedure matched controls without SSI, were also assessed. Chi- square test and Fisher's exact test were used for analysis. P= <0.05 was considered significant.
Results: Out of 1023 patients, 47 cases had SSI, with a rate of 4.6%. Cigarette smoking was a risk factor for SSI (P = 0.0035). The most common etiologic agents were Acinetobacter baumannii and Staphylococcus aureus. Incidence of re- admission among SSI cases was more compared to controls (P= 0.0001). Costs attributable to SSI (Indian Rupees) was Rs 32,542 (17,054 to 87,514) which was significantly more than those without SSI (P= <0.001).
Conclusion: Despite latest surgical amenities, meticulous sterilization protocols and pre-operative antibiotic prophylaxis, SSI continues to be present in healthcare settings. The increase in duration of hospital stay due to SSI adds to additional burden to an already resource-constrained healthcare system.
Antimicrobial resistance pattern in healthcare-associated infections: investigation of in-hospital risk factors
Authors: Emami Meybodi Mohammad Masoud , Foroushani Abbas Rahimi , Zolfaghari Masoome , Abdollahi Alireza , Alipour Abbas , Mohammadnejad Esmaeil , Zare Mehrjardi Ehsan , Seifi Arash
Published: April 2021

Background and Objectives: Antimicrobial resistance (AMR) is an increasing threat for efficient treatment of infections. Determining the epidemiology of healthcare-associated infections and causative agents in various hospital wards helps appropriate selection of antimicrobial agents.
Materials and Methods: This retrospective study was performed by analyzing antibiograms from March 2017 to March 2018 among patients admitted to the different wards of Imam Khomeini Hospital Complex in Tehran, Iran.
Results: Among 2440 hospital acquired infections, 59.3% were Gram-negative bacilli: E. coli (n = 469, 22.2%), K. pneumoniae (n = 457, 21.7%), Acinetobacter spp. (n = 282, 13.4%), P. aeruginosa (n = 139, 6.6%) and important Gram-positive bacteria were Enterococcus spp. (n = 216, 10.2%), S. aureus (n = 148, 7%), S. epidermidis (n = 118, 5.6). Generally, there was a high antimicrobial resistance in bacterial isolates in this study. Methicillin resistant Staphylococcus aureus (MRSA) was 56.3 % and MRSE 62.9 %. Vancomycin resistant enterococci (VRE) was 60.7%. K. pneumoniae- ESBL was 79.6% and its resistance to carbapenem was 38.4%. E. coli-ESBL was 42% and its resistance to carbapenems was 2.3%. P. aeruginosa resistance to ceftazidime was 74.4%, to fluroquinolones 63.3%, to aminoglycosides 64.8%, to piperacillin tazobactam 47.6% and to carbapenems 62.1%. Acinetobacter baumannii resistance to ceftazidime was 98.7%, to fluroquinolones 97%, to aminoglycosides 95.9%, to ampicillin sulbactam 84%, to carbapenems 96.4% and to colistin 4%.
Conclusion: The study revealed an alarming rate of resistance to the commonly used antimicrobial agents used in treating HAIs. Also the relationship between AMR and some risk factors and thus taking steps towards controlling them have been shown.
Macrolide-resistance, capsular genotyping and associated factors of group B Streptococci colonized pregnant women in Isfahan, Iran
Authors: Rostami Soodabeh , Moeineddini Leila , Ghandehari Fereshteh , Rahim Khorasani Marzieh , Shoaei Parisa , Ebrahimi Nasim
Published: April 2021

Background and Objectives: Group B streptococcus (GBS) can cause severe and invasive infections in pregnant women, infants, and adults. This study aimed to investigate the risk factors of GBS colonization in pregnant women and determine the macrolide resistance and capsular type of isolates.
Materials and Methods: In a cross-sectional study, a total of 200 pregnant women were screened for GBS colonization by phenotypic methods. Antibiotic susceptibility pattern of colonizing isolates and ermB, ermTR, mefA/E genes were detected. Also, molecular capsular types of isolates were distinguished.
Results: The overall prevalence of colonization of participates with GBS was 13.5%. Statistical analysis showed that there was no association between risk factors and colonization with GBS. The highest resistance was observed to erythromycin (44.4%) followed by clindamycin (29.6%), penicillin, ampicillin, and ceftriaxone (18.5%), levofloxacin (11.1%), and 29.6% isolates were multidrug-resistant. ermTR and mefA/E genes were detected in 37% and 11.1% isolates; respectively and the ermB gene was not detected. The most common capsular type was type Ib (44.4%) followed by type III (40.7%), type II (11.1), and type Ia (3.7%).
Conclusion: In the present study, the prevalence of GBS was in the medium range. Resistance to key antibiotic agents was relatively high. Also, capsular serotype Ib was the predominant serotype, which emphasizes the importance of monitoring the molecular typing of the GBS isolates regularly.
Occurrence and risk factors of nontuberculous mycobacteria in tuberculosis-suspected patients in the north of Iran
Authors: Shafipour Maryam , Shirzad-Aski Hesamaddin , Allah Ghaemi Ezzat , Sohrabi Ahmad , Taziki Masoumeh , Babai Kochkaksaraei Maya , Rahimi Somayeh
Published: April 2021

Background and Objectives: Some Nontuberculous Mycobacteria (NTM) can occasionally infect the human population and cause infections having symptoms similar to tuberculosis (TB). This study tried to provide updated data about the frequency and diversity of NTM species.
Materials and Methods: Suspicious samples of Mycobacterium tuberculosis (MTB) with both positive results in Ziehl-Neelsen (ZN) staining and Löwenstein-Jensen medium culturing were evaluated during January 2016 and December 2018 in Gorgan, Iran. After determination of MTB isolates by the growth rate, pigmentation status, the niacin test, and the insertion sequence 6110 (IS6110) PCR assay, other unknown isolates (presumably NTM) were detected by the 16S rDNA sequencing method and drawing the phylogenetic tree. Based on the patients’ demographic information, their risk factors were also assessed.
Results: Among 226 culture-positive samples, obtained from 2994 individuals with suspected symptoms of TB, the analyses found 12 (5.3%) NTM and three Mycobacterium caprae isolates. Mycobacterium simiae (6/12) was the most prevalent NTM species. The average nucleotide similarity value was 98.2% ± 3.7. In comparison to patients with MTB (211 confirmed cases), other mycobacterium infections were more common in patients over 65 years old (Odd ratio (95% convenience interval): 2.96 (0.69 - 12.59), P = 0.14).
Conclusion: Although the NTM species has a small portion in TB suspected patients, their prevalence has increased, mainly in elderly patients. Moreover, M. simiae was the most prevalent NTM species in our region. Therefore, identification of common species in each region is recommended and clinicians should pay more attention to them in each region.
Expression of type II toxin-antitoxin systems and ClpP protease of methicillin-resistant Staphylococcus aureus under thermal and oxidative stress conditions
Authors: Karimaei Samira , Sadeghi Kalani Behrooz , Shahrokhi Nader , Mashhadi Rahil , Pourmand Mohammad Reza
Published: April 2021

Background and Objectives: Staphylococcus aureus is a main human pathogen that causes a variety of chronic to persistent infections. Across the diverse factors of pathogenesis in bacteria, Toxin-Antitoxin (TA) systems can be considered as an antibacterial target due to their involvement in cellular physiology counting stress responses. Here, the expression of TA system genes and ClpP protease was investigated under the thermal and oxidative conditions in S. aureus strains.
Materials and Methods: The colony-forming unit (CFU) was used to determine the effects of thermal and oxidative stresses on bacterial survival. Moreover, the expressions of TA system genes in S. aureus strains were evaluated 30 min and 1 h after thermal and oxidative stresses, respectively, by quantitative reverse transcriptase real-time PCR (qRT-PCR).
Results: The cell viability was constant across thermal stress while oxidative stress induction showed a significantly decrease in the growth of Methicillin-Resistant S. aureus (MRSA) strain. Based on the qRT-PCR results, the expression of mazF gene increased under both thermal and oxidative stresses in the MRSA strain.
Conclusion: A putative TA system (namely immA/irrA) most likely has a role under the stress condition of S. aureus. The MRSA strain responds to stress by shifting the expression level of TA genes that has diverse effects on the survival of the pathogen due to the stress conditions. The TA systems may be introduced as potential targets for antibacterial treatment.
vB-Ea-5: a lytic bacteriophage against multi-drug-resistant Enterobacter aerogenes
Authors: Habibinava Fatemeh , Zolfaghari Mohammad Reza , Zargar Mohsen , Sabouri Shahrbabak Salehe , Soleimani Mohammad
Published: April 2021

Background and Objectives: Multi-drug-resistant Enterobacter aerogenes is associated with various infectious diseases that cannot be easily treated by antibiotics. However, bacteriophages have potential therapeutic applications in the control of multi-drug-resistant bacteria. In this study, we aimed to isolate and characterize of a lytic bacteriophage that can lyse specifically the multi-drug-resistant (MDR) E. aerogenes.
Materials and Methods: Lytic bacteriophage was isolated from Qaem hospital wastewater and characterized morphologically and genetically. Next-generation sequencing was used to complete genome analysis of the isolated bacteriophage.
Results: Based on the transmission electron microscopy feature, the isolated bacteriophage (vB-Ea-5) belongs to the family Myoviridae. vB-Ea-5 had a latent period of 25 minutes, a burst size of 13 PFU/ml, and a burst time of 40 min. Genome sequencing revealed that vB-Ea-5 has a 135324 bp genome with 41.41% GC content. The vB-Ea-5 genome codes 212 ORFs 90 of which were categorized into several functional classes such as DNA replication and modification, transcriptional regulation, packaging, structural proteins, and a host lysis protein (Holin). No antibiotic resistance and toxin genes were detected in the genome. SDS-PAGE of vB-Ea-5 proteins exhibited three major and four minor bands with a molecular weight ranging from 18 to 50 kD.
Conclusion: Our study suggests vB-Ea-5 as a potential candidate for phage therapy against MDR E. aerogenes infections.
Immunological detection of AcAMP antimicrobial peptide secreted by Aspergillus clavatus
Authors: Zamani Ehsan , Zargan Jamil , Honar Hossein , Hajizade Abbas , Haji Noor Mohammadi Ashkan , Keshavarz Alikhani Hani , Heidari Ahmad , Hossein Pour Mohammad
Published: April 2021

Background and Objectives: Aspergillus clavatus antimicrobial peptide (AcAMP) is a fungi-derived peptide with a broad spectrum of activity against pathogenic bacteria and fungi. Natural antimicrobial peptides, including AcAMP, have attracted many attentions in the development of new natural antibiotics against pathogenic bacteria, especially multidrug resistant ones.
Materials and Methods: In the present study, acamp gene was codon-optimized and chemically synthesized in pUC57 cloning vector, subcloned into pET28a (+) expression vector and transferred into competent Escherichia coli BL21 (DE3) cells. The expression of AcAMP was induced by addition of Isopropyl β- d-1-thiogalactopyranoside (IPTG) and the expressed peptide was purified by Ni-NTA. BALB/c mice were immunized with the purified peptide and the ability of the immunized mice sera for the detection of the native AcAMP secreted by A. clavatus IRAN 142C was examined through ELISA and Western blotting techniques.
Results: Both ELISA and Western blotting demonstrated the ability of the sera of the immunized mice to detect the native AcAMP.
Conclusion: The results of the present work show that the raised antibody against recombinant AcAMP can be used to detect AcAMP peptide, an issue which paves the way to develop detection kits for the detection of AcAMP-producing organisms, purification of this valuable peptide for further investigations.
Assessment of seroprevalence of Toxoplasma gondii in blood donors applied to the blood center of Gazi University Hospital
Authors: Yılmaz Ayşegül , Yazıcı Engin , Turk Can
Published: April 2021

Background and Objectives: Toxoplasmosis is a life-threatening zoonotic infection in immunosuppressive individuals. Determining the prevalence and seropositivity rates of toxoplasmosis in asymptomatic blood donors is crucial in terms of the risk status of the transmission of this infection to the blood recipients.
Materials and Methods: In this study, the presence and level of the specific Toxoplasma IgG and IgM antibodies in blood donors was investigated by electrochemiluminescence immunoassay (ECLIA). The statistical significance levels between Toxoplasma seropositivity and demographic characteristics of the donors such as age, educational status, raw meat consumption, drinking water supply were examined.
Results: Toxoplasma IgG seropositivity was found among the 225 (25.6%) of the donors present in the study group, while IgM seropositivity was detected in 20 donors (2.3%). The number of donors with only IgM (+) was 8 (0.9%). Both IgG and IgM seropositivities were found in 12 donors (1.4%).
Conclusion: Our study provides information about Toxoplasma seropositivity based on the samples collected from the donors who were admitted to the blood center of a university hospital in Ankara, Turkey. This study demonstrates that Toxoplasma seropositivity is high in the rural areas and the regions where the education level is low.
Relationship between vitamin D levels and brucellosis: a case-control study from Sanandaj, Iran
Authors: Mohsenpour Behzad , Ahmadi Amjad , Mohammadi Baneh Anvar , Ghaderi Ebrahim , Afrasiabian Shahla , Azizi Samaneh , Hajibagheri Katayoon
Published: April 2021

Background and Objectives: Brucellosis is a zoonotic disease that is caused by the Brucella species. This disease is common in Iran and its incidence is increasing .This study measures serum vitamin D levels in patients with brucellosis and healthy people.
Materials and Methods: This research was conducted as a case-control study at Tohid Hospital, Sanandaj, Iran. The calculated sample size included 90 patients in the case group and 90 patients in the control group. The measurement of vitamin D levels in the case and control groups were performed by ELISA.
Results: The mean serum vitamin D level was 19.91 ng/ml in the case group and 22.87 ng/ml in the control group. (Serum vitamin D level <10 ng/mL is accepted as deficiency, 10-30 ng/mL as insufficiency, 30-100 ng/mL as sufficiency, and >100 ng/mL as toxicity).
Conclusion: There was no significant difference between the two groups in terms of vitamin D deficiency (p-value=0.097).
Latest Effective Measures to Combat COVID-19: A Review
Authors: Chen Fei , Liu Yingjie , Ya Bailiu , He Jiarui , Leng Taiyang , Sun Yike , Xin Qing
Published: April 2021

More and more people realize that implementation of preventive measures is the only option left to counteract the coronavirus disease 2019 (COVID-19) before specific antiviral drugs are developed. Hence, a number of behavioral, clinical and state interventions have been conducted by dozens of countries to stop or slow down the spread of the virus in the early stages of the epidemic. At present, with the evolution of COVID-19 pandemic getting worse, synthesizing and implementing all measures available are of paramount importance. However, some measures are still being controversial. We aimed to assist policymakers in decision making for better pandemic preparedness. We reviewed the literature that reported accumulated scientific experience to date and summarized the epidemic prevention and control measures in three aspects: control the source of infection, cut off the routes of transmission and protect the susceptible population. First of all, some new approaches were introduced to control the source of infection, such as implementing contact-tracing apps, nucleic acid mixed detection, repeated testing and the establishment of some specialized laboratories. Second, we need to take various measures to cut off all possible routes of transmission, especially persistently pay close attention to checking cold chain foods. Third, due to no valid vaccine has yet been developed, some measures that can cut development time of more conventional vaccines should be implemented or considered. By synthesizing the scientific experience in fighting the COVID-19 epidemic, we suggested the latest effective measures should be carried out concurrently from three aspects, so as to avoid making grim situation even worse.
A 50-Year Overview of the Coronavirus Family with Science Mapping Techniques: A Review
Authors: Tabur Ayhan , Arslanoğlu Ali
Published: April 2021

Background: The COVID-19 pandemic from the coronavirus family is the most important agenda of today's world, also called the “New World”. In this outbreak period, declared a pandemic by WHO and affected the whole world and humanity on a global scale, all kinds of scientific information and evidence-based sharing on the subject gained great importance.
Methods: Overall, 12,301 articles from the web of Science (WOS) Core Collection database were analyzed using SciMAT software, conducted to examine the development of coronavirus publications in the process and to reveal the scientific mapping related to the subject. To analyze the development in the process based on periods, the articles covering the 50 years were compared as five periods of 10 years.
Results: The most publications with the Coronavirus theme were made between 2010 and 2020 (n=1020), the total number of citations of these articles was 15,966 and the h-index value was 54. The theme "Coronavirus” was associated with the themes “infection” (w=0.04), “SARS” (w=0.03), “virus” (w=0.04), “identification” (w=0.05) and "swine" (w=0.03). Due to the recent emergence of the COVID-19 theme, it was found to be directly related to the “outbreak” theme (w=0.01). In terms of the distribution of the articles on coronavirus by country, most articles were published by the USA. This country is followed by China, Germany, England and the Netherlands.
Conclusion: This research on the coronavirus family can offer a holistic view of the virus family in the scientific world and can make a scientific contribution to the fight against the virus by creating awareness on this issue.
Oral Health and Related Quality of Life in Older People: A Systematic Review and Meta-Analysis
Authors: Azami-Aghdash Saber , Pournaghi-Azar Fatemeh , Moosavi Ahmad , Mohseni Mohammad , Derakhshani Naser , Alaei Kalajahi Riaz
Published: April 2021

Background: Of the most important implications and complaints in the elderly group of the population, is oral and dental health problems. This study aimed to assess oral health- related quality of life in older people.
Methods: To data collection, databases were searched including PubMed, EMBASE, Scopus, SID, MagIran, Cochrane Central Register of Controlled Trials and scholar google The keywords were “older adults", “Geriatric” Elderly", "Older", “Aged”, "Ageing", "Oral health", "Oral hygiene" and "Quality of life", "QOL. For manual searching, several specialized journals of related scope as well as the finalized articles' reference list were searched. Studies from 1st Jan 2000 to 30th Jan 2017 were included. Studies were subjected to meta-analysis to calculate indexes, using CMA:2 (Comprehensive Meta-Analysis) software.
Results: Totally, 3707 articles were searched that 48 of them were subjected to the oral and dental health-related quality of life in 59 groups of the elderly population with the mean age of 73.57+6.62 in the 26 countries. The obtained percentage values of dental and oral health were 80.2% (0-60), 14.8% (0-12), 16.4% (0-70), 22% (0-14 or 0-59) and 19.2% (0-196) for GOHAI with the additive method, GOHAI with Simple Count Method, OHIP14 with the additive method, OHIP-14 with Simple Count method and OHIP-49 with additive method indexes, respectively.
Conclusion: The elderly group of the population had no proper oral health-related quality of life. Regarding the importance and necessity of oral and dental health and its effect on general health care in the target group, it is recommended to improve dental hygiene in the mentioned group of population.
Does Behavior Pattern Influence Blood Pressure in the Current Cultural Context of Japan?
Authors: Fukita Susumu , Kawasaki Hiromi , Yamasak Satoko
Published: April 2021

Background: Type A behavior pattern has been presented as a risk for coronary heart disease and defined as a psychological-behavioral construct. This study aimed to identify the influence of type A behavior pattern on blood pressure in the current cultural context of Japan.
Methods: This study utilized a cross-sectional design. Self-administered questionnaires were distributed to community residents aged 40-59 yr in western Japan from Aug to Sep 2017. The data included participant’s demographic information (including socioeconomic variables); information related to blood pressure, type A behavior pattern, psychological factors, and health-related behaviors. Logistic regression was used to identify the influence of type A behavior pattern on systolic blood pressure after adjusting for behavioral, psychological, and socioeconomic factors
Results: The sample included 362 participants with a mean age of 51.5 years (SD = 5.96); 148 (41.2%) men. A logistic regression demonstrated that type A behavior pattern was negatively associated with systolic blood pressure (OR = 0.43, 95% CI [0.22, 0.83]) after adjusting for sex and age. Similar results were observed after adjusting for other covariates.
Conclusion: There may be a negative association between type A behavior pattern and systolic blood pressure among adults living in the current cultural context of Japan.
Effect and Mechanism of Transthyretin Over-Expression on Proliferation and Cell Cycle of Lung Cancer A549 Cells
Authors: Zhu Deqing , Li Xuan , Gong Hao , Li Jing , Lu Xike , Xia Honggang , Chen Xia , Ma Lan , Sun Zhongyi , Zhang Xun , Wang Dongbin
Published: April 2021

Background: The effects of transthyretin (TTR) over-expression on the proliferation and cell cycle of nonsmall cell lung cancer (NSCLC) A549 cells and its possible mechanism were verified.
Methods: A total of 196 LC patients and 20 healthy controls were enrolled at Tianjin Hospital, Tianjin, China between Apr 2017 and Oct 2017. The serum TTR content was detected by ELISA. Through lentiviral transfection method, NSCLC cells were divided into non-transfected group (group A), negative control group (group B) transfected with empty vector and experimental group (group C) transfected with TTR overexpression. Cell proliferation was detected by CCK-8 method, TTR mRNA expression was detected by realtime quantitative polymerase chain reaction (RT-qPCR), and TTR protein expression was tested by Western blot (WB). Cell cycle was detected by flow cytometry, Wnt3a/β-catenin protein expression was detected by WB, and mRNA expression was detected by RT-qPCR.
Results: The serum TTR content in early, middle and late LC group was remarkably lower than that in healthy group (P<0.05). Compared with late stage, TTR content in early and middle stages of LC group was higher, and the difference was statistically marked (P < 0.05). The absorbance value of group C was lower than that of groups A and B, indicating that the cell proliferation activity dramatically decreased, with statistically marked difference (P<0.05). LC A549 cells in group C were obviously blocked in G2M, with statistical significance (P<0.05).
Conclusion: TTR over-expression can inhibit the proliferation of NSCLC A549 cells, and the expression is related to Wnt3a/β-catenin pathway. TTR in serum of patients was helpful for diagnosing LC and has certain clinical value.
Influences of Psychological Intervention on Negative Emotion, Cancer-Related Fatigue and Level of Hope in Lung Cancer Chemotherapy Patients Based on the PERMA Framework
Authors: Tu Min , Wang Fan , Shen Sanying , Wang Hui , Feng Jing
Published: April 2021

Background: Psychological status is a decisive factor for regulating the lung cancer chemotherapy patients’ levels of fatigue and hope. Using the PERMA (Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment) framework. We aimed to explore the influences of the psychological intervention on the patients’ negative emotion, cancer-related fatigue, and level of hope.
Method: A total of 100 lung cancer chemotherapy patients admitted in Wuhan No.4 Hospital, China, from Jan 2018 to Aug 2019 were enrolled as research objects divided into the control group and observation group. Positive psychological intervention using the PERMA framework was given to the observation group. The scores of Post-Traumatic Growth Inventory (PTGI), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Cancer Fatigue Scale (CFS), and Herth Hope Index (HHI) were evaluated and compared in the two groups.
Results: After the intervention, PTGI score in the observation group is higher than that in the control group, whereas the SAS and SDS scores are lower in the observation group than in the control group, and the differences are statistically significant (P<0.05). Score of each CFS dimension and total CFS score in the observation group are all lower than those in the control group, with statistically significant differences (P<0.05). Score of each HHI dimension and total HHI score are higher than those in the control group, and the differences are statistically significant (P<0.05).
Conclusion: Positive psychological intervention using the PERMA framework can improve the emotional and fatigue state of lung cancer chemotherapy patients and elevate their level of hope.