Acta Medica Iranica
Volume:60 Issue: 7, Jul 2022

Artificial intelligence applications are known to facilitate the diagnosis and the treatment of COVID-19 infection. This research was conducted to investigate and systematically review the studies published on the use of artificial intelligence in the COVID-19 pandemic. The study was conducted between April 25 and May 6, 2020 by scanning national and international studies accessed in "Web of Science, Google Scholar, Pubmed and Scopus" databases with the keywords ("Coronavirus” or “COVID-19") and ("artificial intelligence" or “deep learning” or “machine learning”). As a result of the scanning process, 1495 (Google Scholar: 1400, Pubmed: 58, Scopus: 30, WOS: 7) studies were accessed. The studies were first examined according to their titles, and 1385 studies, which were not related to the research topic, were not included in the scope of the research. 50 articles, which did not meet the inclusion criteria, were excluded. The abstract and complete texts of the remaining 60 studies were scanned for the study's inclusion and exclusion criteria. A total of 10 studies, consisting of reviews, letters to the editor, meta-analysis studies, animal studies, conference presentations, studies not related to COVID-19, and incomplete studying protocols, were excluded. There were 50 studies left. 9 articles with duplication were identified and excluded. The remaining 41 studies were examined in detail. A total of 26 researches were found to meet the criteria for the systematic review study. In this systematic review, AI applications were found the be effective in COVID-19 diagnosis, classification, epidemiological estimates, mode of transmission, distribution and density of lesions, case increase estimation, mortality/mortality risk and early scans.

Clinical Case    A 5-year-old female child, who consulted for pigmented patches involving the posterior surface of the trunk, buttocks and upper one third of both legs. There were hairy surface, dark, black colour and a sharply bordered measuring 29×39.5 cm (Figure 1).    The physical  examination of child was normal. There was no history of other congenital anomaly or neurological deficit . No abnormality(bleeding or ulceration )was detected in the lesions. She was a product of non- consanguineous marriage. Both parents were healthy and none of the close family members had similar skin lesions.    A clinical diagnosis of Giant congenital melanocytic nevus (GCMN) was made. The patient was advised frequent follow-up visits and the performed screening procedures, including ultrasound and CT scan of lumbosacral region, did not reveal any abnormalities.

Colorectal cancer (CRC) is common cancer with a high mortality rate worldwide. Cyclin D1 is a gene that regulates cell cycle passage from stage G1 to S (G1/S checkpoint) and has recently been linked to the prognosis of a variety of cancers. Therefore, the aim of this study was to investigate the expression of cyclin D1 in colorectal cancers and its relationship with clinicopathologic factors. In this retrospective study, paraffin blocks of tumors of consecutive CRC patients registered in the histopathology laboratory of hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences were used. Patients' clinicopathologic findings were extracted from their files, and using paraffin blocks, specific staining for cyclin D1 was performed using the immunohistochemistry method. Data were analyzed by SPSS software. In terms of staining, 11 samples (28.9%) scored 4, 11 samples (28.9%) scored 3, 8 samples (1/21%) scored 2, 3 samples (7.9%) scored 1, and 5 samples (2/13٪) scored zero. Staining intensity was severe in 10 cases (26.3%), moderate in 14 cases (36.8%), mild in 8 cases (21.1%), and negative in 6 cases (15.8%). The severity and extent of staining had no significant relationship with sex, age, tumor location, degree of differentiation (grade), depth of invasion, tumor size, lymph node involvement, and vascular and perineural invasion (P>0.05). Despite the high expression of cyclin D1 in colorectal carcinoma, no significant relationship was observed between its expression and prognostic factors, which is probably due to the small sample size.

Remdesivir, an antiviral medication, became an early promising therapeutic candidate for coronavirus disease 2019 (COVID-19) due to its ability to inhibit the virus in vitro. Current evidence about remdesivir treatment has been very controversial, so we aim to evaluate remdesivir to improve our knowledge about COVID-19 management and its long-term effects. In this retrospective cohort study using registered data derived from the Sina Hospital COVID-19 Registry with a 9-month follow-up, we enrolled patients receiving remdesivir and then matched a "control group" which did not receive remdesivir based on age, gender, and severity using propensity score matching. We used multivariant Cox regression to evaluate the remdesivir effect on patients' 9-month and in-hospital survival. We enrolled 227 patients, 116 in remdesivir and 111 in the control group. 213(93.8%) patients developed the severe disease, 88(38.8%) died during the 9-month follow-up, and 84(37.0%) died during hospitalization. In multivariate analysis, remdesivir did not affect the 9-month all-cause mortality and in-hospital mortality. Remdesivir was associated with increased in-hospital survival only in severe patients with diabetes (HR: 0.32; 95% CI: 0.14-0.75; P:0.008), and there was a trend for better 9-month survival in severe patients with diabetes (HR: 0.47; 95% CI: 0.20-1.09; P:0.080). We concluded that remdesivir treatment did not increase the 9-month survival rate either in patients with COVID-19 or patients with severe disease and underlying diseases. On the other hand, we found that remdesivir treatment could increase in-hospital survival only in patients with severe COVID-19 and a history of diabetes mellitus.

During the coronavirus disease-2019 (COVID-19) pandemic, which was caused by the novel coronavirus, there is an ongoing controversy about the use of corticosteroids. This study aims to investigate the association between Dexamethasone treatment and clinical outcomes in patients with severe COVID-19. In this single-center retrospective cohort study, patients with COVID-19 were enrolled from February 16, 2020, to November 1, 2020. After performing propensity score matching with age, sex, and disease severity. The independent effect of Dexamethasone treatment on in-hospital mortality was evaluated by multivariate proportional hazards regression models. Of 1413 patients with COVID-19 diagnosis, 1172 patients entered the final analysis. 473(40.4%) patients received dexamethasone treatment with a median duration of 6.0[4.0-9.0] days. After matching and adjustment with possible confounders in the multivariate model, administration of dexamethasone significantly increased the survival in severe patients (hazard ratio: 0.25, 95 confidence intervals: 0.16-0.38, P<0.001), but there was no difference in non-severe patients (P:0.888). The administering of dexamethasone was associated with an increased in-hospital survival rate (HR: 0.25 [0.16-0.38]) in severe COVID-19 patients. The survival rate was more significant in severe patients with diabetes mellitus or hypertension after receiving dexamethasone treatment (HR:0.19). On the other hand, patients without severe disease did not benefit from dexamethasone administration.

 Postoperative pain is one of the most important factors in the recovery process after surgery. The incision site of tympano-mastoidectomy is related to the innervation of the superficial cervical plexus. The aim of this study is to evaluate the effect of superficial cervical plexus block on reducing post-tympano-mastoidectomy pain. This is a prospective, double-blind clinical trial study, and patients aged 20-61 years who were candidates for tympano-mastoidectomy were included in the study and were randomly divided into two groups. Before induction of general anesthesia, the subjects underwent superficial cervical plexus block with ultrasound guidance, injection of ropivacaine 0.2% in the treatment group, and normal saline in the control group, respectively. Hemodynamic parameters, intraoperative remifentanil used to maintain hemodynamic stability, the severity of perioperative pain, nausea and vomiting, and perioperative analgesic use were compared between the two groups. Pain intensity in the recovery phase, 2, 6, 12, and 24 hours after surgery in the treatment was 2.6, 1.8, 1.4, 0.5, and 0.4 and in the control, group was 3.7, 2.5, 2.1, 1.5, and 0.9, respectively (P<0.05). Intraoperative use of remifentanil was 410±622.2 µg in the block group and 1340±448.4 µg in the control group, respectively. The need for opioid administration was 8.2±10.4 mg in the block group and 13±13.2 mg in the control group, respectively (P=0.046). The need for administration of diclofenac in the first 24 hours after surgery was 8±27.4 mg in the treatment group and 54±50 mg in the control group, respectively (P<0.001). Superficial cervical plexus block can significantly reduce pain and the need for opioid administration after the tympano-mastoidectomy operation.

Vitiligo is the most common cause of skin depigmentation, which relates to a wide range of psychological disorders. Stigma is defined as a negative attitude towards oneself that results from one's perception of being different from the general population. In this study, we have evaluated the quality of life and stigmatization degree among vitiligo patients. In this cross-sectional study, 323 patients with vitiligo referred to Razi Hospital, Tehran, Iran, were evaluated. All patients were asked to fill out a questionnaire containing age, gender, marital status, educational level, employment status, duration of vitiligo, location of lesions, history of underlying diseases, history of previous treatments, as well as history of depression or suicide. Quality of life and stigmatization among patients were assessed by DLQI (dermatology life quality index) and FSQ (feeling stigmatization questionnaire) questionnaires. The prevalence of moderate and severe stigmatization were 49.8 % and 13.3%, respectively. Women were significantly more stigmatized than men. The presence of vitiligo lesions on the face, hands, or forearms, previous topical and oral treatments, and prior depressive disorders were significantly associated with an increased sense of stigma. Patients with thigh or trunk lesions faced less stigmatization. Additionally, stigmatization was meaningfully related to the level of quality of life impairment. In the present study, 63% of patients with vitiligo experienced moderate to severe stigmatization levels related to gender, lesion site, history of prior treatments, and depression. Moreover, there was a significant correlation between the level of stigma sensation and the life quality disturbance.

Stenotrophomonas maltophilia is resistant to a wide range of antibiotics. This study aimed to investigate the beta-lactamase, ESBL, and MBL enzymes and also L1and NDM1 genes in isolates of Stenotrophomonas maltophilia. Antibiotic susceptibility test, beta-lactamase, ESBL, and MBL test was done on 23 isolated Stenotrophomonas maltophilia. The presence of L1 and NDM1 genes was investigated on isolated MBL bacteria by the PCR method. The results showed the most effective antibiotics were tigecycline and gentamicin (100%) and the highest resistance was observed with aztreonam (56.22%). 39.13% of isolates were ESBL, 82.66% of isolates were beta-lactamase positive, 60.86% of isolates were Metallo-beta-lactamase positive. 39.13% of MBL positive isolates, were positive for the L1 gene but the NDM1 gene was not seen. Results of this study showed the higher resistance to beta-lactam antibiotics also the presence of the l1 gene. ESBL and MBL producing S. maltophilia are frequently resistant to a wide range of antibiotics. Therefore, needs to be done antibiotic sensitivity test, ESBL, and MBL test before treatment for this bacterium.

Medical universities need faculty members (FMs) who use high-level thinking and the power of reason to make decisions in conflicting situations. The purpose of this study was to determine the relationship between critical thinking skills and conflict management styles in the Medical University FMs (MUFMs). A descriptive cross-sectional study using the stratified sampling and then Quota sampling was performed. The sample size was 160 people. The Thomas and Kilman's Questionnaire for Conflict Management Style and Critical Thinking Questionnaire Form B were used. This study showed that the total score of faculty members' critical thinking was lower than the expected mean. The participants have more deductive thinking skills. Other skills are descending respectively, including inductive thinking skills, evaluation, inference, and analysis. In the Conflict Management styles, the Compromising style scored the highest. And other styles are used in descending respectively, including; conflict management styles avoidance, competition, and collaboration. This study showed that the Compromising Conflict Management Style was the highest among the FMs and, in contrast to the Collaborating conflict management style, scored the lowest. The deductive Critical thinking skill scored the highest; in contrast, the analysis critical thinking skill was the least scored. This study showed that by increasing the total score of critical thinking skills of participants, the using of avoidance and compromising conflict management style is more likely.