Original Article

Evaluation of the Clinical, Laboratory and Imaging Findings of Patients with COVID-19 and Their Associations with Clinical Outcomes in an Iranian Hospital: A Cross-Sectional Study

Shabnam Tehrani, Davood Yadegarinia, Sara Abolghasemi, Shahnaz Sali, Alireza Abrishami, Hamideh Moradi, Neda Khabiri

Novelty in Biomedicine, Vol. 9 No. 4 (2021), , Page 165-170

Background: Coronavirus disease 2019 (COVID-19) is a concern in the medical community as the virus spreads around the world. It has a heavy global burden, particularly in low-income countries. This virus has its specific outcomes in each population. Hence, it is necessary to design studies to find the epidemiological behaviour of this virus.

Materials and Methods: This cross-sectional study was conducted in the Labbafinezhad hospital, Tehran, Iran. Demographic features include age, sex, past medical history, drug history, habitual file, influenza vaccination history, recent exposure history, clinical symptoms or signs, and the recorded symptoms. The clinical examination and para-clinical assessment, including chest computed tomography (CT) and laboratory testing on admission, were recorded.

Results: It was found that patients with a history of kidney transplantation, high level of LDH, high level of AST, and increased neutrophil to lymphocyte ratio are most at risk of death.

Conclusion: Parameters mentioned could help practitioners predict patient outcomes, and necessary interventions could be considered in this regard.

Hepatic Involvement and Association with Prognosis in COVID-19 Patients: A Single-Centre Report from Iran

Amirhassan Rabbani, Mana Baziboroun, Hesam Akbari, Mohamad Pishgahi, Sedigheh Nazari

Novelty in Biomedicine, Vol. 9 No. 4 (2021), , Page 171-177

Background:There were no documents about the non-lung involvement of COVID-19, even in the absence of lung involvement. The present study aimed to report a single-centre experience of liver involvement caused by COVID-19 disease in Iran.

MaterialsandMethods:We recorded information of 120 patients who suffered COVID-19 disease, and they were admitted to the intensive care unit at Taleghani hospital in Tehran, Iran, between March and May 2020. Along with clinical and diagnostic parameters, the outcome of patients concerning improvement, disease progression or death was also assessed.

Results:In total, 68 patients (56.7%) had abnormal liver dysfunction. The most common changes in liver-related parameters were elevated international normalized ratio (INR) (mean serum level of 2.5) followed by elevated alkaline phosphatase (ALP) (mean serum level of 412 mg/dl). The mean level of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) increased 4 and 9 times more than the standard limit. The overall death rate in COVID-19 patients was 38 patients (55.88%, n=68).

Conclusion:Liver injuries are common findings in patients suffering COVID-19 infection and leading to poorer outcomes. Serum bilirubin level of more than 3mg/dl was associated with higher mortality in patients with liver damage.

Evaluation of the Enzymatic Activity of Soluble CD13/APN and CD26/DPP4 in Serum and Urine Samples of Mice with Experimental Autoimmune Encephalomyelitis

Sanaz Mami, Elnaz Farahani, Fattah Sotoodehnejadnematalahi, Anwar Fathollahi, Mostafa Hajimolahoseini; Ramin Pouriran; Farshid Yeganeh

Novelty in Biomedicine, Vol. 9 No. 4 (2021), , Page 178-184

Background: Dipeptidyl Peptidase IV (DPP4/CD26) and Amino Peptidase N (APN/CD13) have essential roles in inflammatory diseases. The current study aimed to determine changes in APN and DPP4 enzyme activity in the serum and urine of mice with experimental autoimmune encephalomyelitis (EAE).

Materials and Methods: In the present study, female C57BL/6 mice were studied in two groups (control and EAE). Twenty-sevendays after induction, the enzymatic activity of APN and DPP4 in urine and serum samples was measured using a spectrophotometric assay.

Results: The enzyme activity of DPP4 was higher in serum and urine of EAE mice than in the control group (mean in serum: 1.04 ± 0.13 pmol/mL and 0.80 ± 0.12 pmol/mL, respectively, P=0.015; mean in urine: 0.26 ± 0.04 pmol/mL and 0.19 ± 0.04 pmol/mL, respectively, P=0.015). However, the enzymatic activity of APN in serum and urine of mice with EAE when compared to the control group had no significant difference (mean in serum: 9.20 ± 1.15 unit/mL and 10.25 ± 1.21 unit/mL, respectively, P=0.132, mean in urine: 0.23 ± 0.27 unit/mL and 0.15 ± 0.05 unit/mL, respectively, P=0.310).

Conclusion: The increased DPP4 activity along with normal APN activity in urine and serum samples can be used as an indicator to detect or follow up on the course of MS disease. Confirmation of this finding needs further investigation.

Determination of Species of Leishmania Using HSP70 Gene in Patients Referred to Selected Health Centers of Iran

Farid Tahvildar Biderouni, Fatemeh Ali Bakhshi, Niloofar Taghipoor, Maryam Norouzi

Novelty in Biomedicine, Vol. 9 No. 4 (2021), , Page 185-193

Background: Cutaneous leishmaniasis is caused by Leishmania major and Leishmania tropaica. Iran is considered as one of the world's largest leishmaniosis centers. In this study, the restriction fragment length polymorphism (RFLP)-PCR method was used to determine the species of pathogenic parasites.

Materials and Methods: In this cross-sectional study, 120 patients with suspected cutaneous ulcer referring to the selected medical centers of Shahid Beheshti University of Medical Sciences were selected. Their demographic characteristics were recorded. After diagnosis of parasite by microscopy, positive samples were cultured in NNN medium. After DNA extraction of cultured parasite, PCR was performed for amplification of the HSP70 gene. The PCR products were digested with HaeIII restriction enzyme; the obtained patterns were compared with the same genes in the GenBank database.

Results: A 1422 base pair fragment was detected in PCR of HSP70 gene in 30 positive samples. After digestion, 16 (53.3%) of the samples, had an enzymatic digestive pattern compatible to L. major and 14 (46.7%) others had the L. tropica profile. More information concerning demographic aspects were obtained after analyses them with the infected samples.

Conclusion: Regarding the history of patient trips to their hometown, the transfer does not appear to have occurred in areas covered by the university's medical centers, but the presence of these patients in these areas requires careful monitoring them. Additionally, control of population and mosquito species is needed. The results of this study sustain that the HSP70 gene still has sufficient ability to differentiate between two different species of L. major and L. tropica.

Review Article

The Potential Impact of the Orexinergic System on the Symptoms of Coronavirus-Infected Patients

Muhammad Haddad, Homayoun Khazali, Mahyar Janahmadi

Novelty in Biomedicine, Vol. 9 No. 4 (2021), , Page 194-203

Coronavirus disease in 2019 (COVID-19) is a pandemic declared by the World Health Organization after its appearance in the Chinese city of Wuhan in late 2019. It has infected more than 30 million people worldwide and led to the death of nearly one million of them. Orexin-A (OXA), a neuropeptide produced by the lateral hypothalamic area and several peripheral tissues, regulates appetite, reproduction, and other physiological functions. There are many symptoms associated with infection with the coronavirus, such as a cytokine storm, narcolepsy, impaired senses of smell and taste, and loss of appetite, usually are associated with high or low levels of OXA in the infected people. Moreover, some chronic diseases such as cancer, diabetes, and obesity, generally referred to as risk factors for the disease, increase the severity of infection or even lead to death and they are associated with either an increase or a decrease in OXA levels. Moreover, some factors, such as a high testosterone level, facilitate the entry of a virus into the cells, which OXA controls. In this review, we described for the first time the potential impact of high or low levels of OXA on the severity of the symptoms of COVID-19 or the death due to this disease.

Short Communication

A survey of Free-Living Amoebae (FLAs) in Nasal Mucosa of Healthy Individuals using Culture-based Method

Zahra Arab-Mazar, Maryam Niyyati, Hamed Behniafar, Zohreh Lasjerdi

Novelty in Biomedicine, Vol. 9 No. 4 (2021), , Page 204-206

Free-living amoebas (FLAs) are facultative parasites, and some of them can be highly pathogenic for animals and humans. These protozoan are found in abundance in environmental resources such as freshwater and soil, and thus the possible colonization of such FLA is probable. Our previous studies showed that Acanthamoeba spp. can colonize nasal mucosa of immunosuppressed patients. However, there was no report of colonization of free-living amoebae in healthy individuals in Iran.  The present study was conducted to investigate the possibility that FLAs are the normal flora of the nasal mucosa. Overall, 46 nasal swab samples were collected from healthy individuals and cultured on a 1.5% non-nutrient agar (NNA) plate enriched with a lawn of heat-killed Escherichia coli. The plates were incubated at room temperature. After one week, the plates were microscopically examined, and this was continued for one month. None of the samples were found positive for FLAs. Our findings may indicate that FLAs are not the normal flora of the nasal mucosa, or their number is so limited in the nasal mucosa that they cannot be isolated by the method used. However, supplementary and comprehensive studies are recommended.

Case Report

Intrauterine Bowel Rupture of Fetus from Stab Wound Injury in a Pregnant Woman: A Case- Report

Atefeh Ebrahimi, Nahid Rezaei Aliabad, Yekta Parsa

Novelty in Biomedicine, Vol. 9 No. 4 (2021), , Page 207-209

Background: Penetrating injuries of the uterus are rare complications during pregnancy which happen most by stab and gunshot wounds. Although the fetus is enclosed within the protective shield of the uterus, it is vulnerable to forceful trauma to the maternal abdomen.

Cases Report: Following an upper abdominal stab wound to the 18-week pregnant mother, fetal death had occurred in the uterine. She was resuscitated and underwent exploratory laparotomy and hysterotomy. The patient had a 3cm laceration on the upper anterior fundus, which has caused the rupture of membrane, leading to fetal death and protruding of bowel loops. After surgery, she was transformed into the recovery room with stable hemodynamic status.

Conclusion: Trauma during pregnancy is a significant burden due to morbidity and mortality that follows mother and fetus for developed countries. The ultimate purpose is to provide optimal care for a mother and fetus.

Anesthesia Management in a Hypertrophic Cardiomyopathy Patient with Brain Tumor: A Case Report

Hamidreza Azizi Farsani, Sogol Asgari, Faranak Behnaz

Novelty in Biomedicine, Vol. 9 No. 4 (2021), , Page 210-214

Background: Brain tumour surgeries are high-risk because of their potential for postoperative fetal complications. This risk is exaggerated in the presence of hypertrophic cardiomyopathy (HCM). Hypertrophic cardiomyopathy includes asymmetric left ventricular hypertrophy with mitral valve dysfunction that obstructs the left ventricular outflow tract. Various postoperative factors may accelerate this obstruction and lead to life-threatening consequences. Hypertrophic obstructive cardiomyopathy (HOCM) is a type of HCM that obstructs the left ventricular outflow tract. The most important parameters are preload, afterload, and ventricular contraction, resulting from the surgical method, anesthesia factors, and changes in intravascular volume that are prone to fluctuations in HOCM patients in the postoperative period. These cases increase the risk of arrhythmias and myocardial ischemia and significantly increase patients' morbidity and mortality after surgery. It should avoid lowering blood pressure, increasing heart rate, and reducing preload and afterload in these patients.

Cases Report: In this study, we reported a 59 years old man who complained of a speech disorder that had worsened three months ago and mentioned a history of hypertrophic cardiomyopathy. The patient underwent brain tumor surgery and was discharged from the hospital with proper management of anesthesia.

Conclusion: Loading and maintaining sinus rhythm are recommended to prevent complications. We presented the intraoperative management of a patient with HCM undergoing a brain tumour resection and discussed its complications.

Petersen’s Hernia as a Complication of Bariatric Surgery: A Case Report

Pooneh Dehghan, Alireza Ghanbari, Javad Khoshrou

Novelty in Biomedicine, Vol. 9 No. 4 (2021), , Page 215-217

Background: Bowel obstruction due to Petersen hernia is a known but rare late complication of a R-Y surgery that can be a life threatening condition.  Delayed intervention may result in a high morbidity and even mortality. The clinical findings are not specific, In this context, imaging exams have an important part in the early detection and surgery of this condition.

Cases Report: We describe the case of a 46-year old man presenting with acute abdominal pain and a history of gastric bypass five years previously. Abdominal Ultrasound did not reveal any significant findings. Indeed, through the use of multi slice computed tomography with IV and oral contrast , diagnosis of internal hernia was made and confirmed by laparotomy.

Conclusion:Internal hernias are rare and difficult to diagnose, but they should be included in the differential diagnosis in intestinal obstruction cases and a history of abdominal surgery to reduce the high morbidity and mortality rates; surgical intervention shouldn’t be delayed.