Caspian Journal of Internal Medicine
Volume:13 Issue: 1, Winter 2022

Reverse transcription polymerase chain reaction (RT-PCR) is the current standard of reference in the diagnosis of SARS-CoV-2 infection. In outpatient clinical practice, nasopharyngeal swab RT-PCR testing is still the most common procedure. The purpose of this systematic review and meta-analysis was to evaluate the sensitivity of RT- PCR nasopharyngeal assays.

We searched three databases, including PubMed/MEDLINE, EMBASE, and Cochrane Library, using a comprehensive strategy. Studies investigating the sensitivity of SARS-CoV-2 RT-PCR nasopharyngeal assays in adults were included. Two reviewers extracted data and assessed trial quality independently. Pooled sensitivity and its confidence interval were computed using the meta package in R.

Thirteen studies were found eligible for the inclusion in the systematic review. Out of these, 25 different sub-studies were identified and included in the meta-analysis, which reported the sensitivities of 25 different nasopharyngeal RT-PCR assays. Finally, the overall pooled sensitivity resulted 89% (95% CI, 85.4 to 91.8%).

Our study suggests that RT-PCR assays on nasopharyngeal specimens have a substantial sensitivity for diagnosing SARS-CoV-2 infection.

Hypertension disease as an absolute risk factor of Covid-19 disease has been well-proven in recent evidence. The factors such as the use of antihypertensive drugs, protein expression, and compensatory axes resulted in hypertension disease playing very important roles in the occurrence of this problem. In this review study, we first attempted to investigate the higher chance reason for Covid-19 disease in people with high blood pressure; then we examined the related mechanisms, and finally, we reported the differences and similarities between people with high blood pressure and athletes. All in all, we concluded that people who exercise regularly, the same as hypertensive patients (Compensatory mechanism) are more susceptible to COVID-19 infection due to the high concentration of ACE2 (Physiological mechanism) caused by exercise adaptation, but for the low level of ANG2 (Systematic and gene expression) these individuals (Active subjects) indicate fewer complications and severity symptoms of COVID-19 such as dyspnea, hospitalization and, heart disease compared with hypertensive patients.

Women live longer than men. Cardiovascular disorders, cancers, and serious infectious conditions are less common among women than men. Recent data also indicate that women, particularly before menopause, are less susceptible to severe COVID-19, a viral infection hitting less-healthy individuals. The superiority of women regarding health has not been completely understood and partly been explained by estradiol beneficial effects on the microenvironment of the body, notably cytokine network. Estradiol cycles are aligned with menstruation cycles, a challenge for distinguishing their individual effects on human health. Large-scale, long-term studies indicate that hysterectomy, particularly at younger ages, is associated with an increased risk of mortality, cancer, or heart disorders. The underlying mechanisms for the increased risk in hysterectomized women are hard to be investigated in animal models since only a few primates menstruate. However, blood exchange models could resemble menstruation and provide some insight into possible beneficial effects of menstruation. Sera from animal models (neutral blood exchange) and also humans that have undergone therapeutic plasma exchange enhance the proliferation of progenitor cells in the culture and contain lower levels of proinflammatory factors. If menstruation resembles a blood exchange model, it can contribute to a healthier cytokine network in women. Consequently, menstruation, independently from estradiol health beneficial effects, can contribute to greater longevity and protection against certain disorders, e.g., COVID-19, in women. Investigation of COVID-19 rate/severity in hysterectomized women will provide insight into the possible beneficial effects of menstruation in COVID-19.

Since the outbreak of COVID-19, various treatments have been frequently reported for patients infected with this virus, especially in transplant patients/recipients.

Investigating of kidney transplant patients under immunosuppressive therapy infected with COVID-19 can pave the way to understanding, handling, and treatment of COVID-19.

We had a brief review of the literature on immunosuppressive therapy in kidney transplants infected with COVID-19. This was based on the PubMed Database with keywords “kidney, transplant, COVID-19, and immunosuppress” after hospitalization of kidney transplantation infected with COVID-19. He had already been recorded in the Organ Transplant Registry (ID≠ 64510) of Tabriz University of Medical Sciences /Iran.

We reported the clinical course of a 45-year-old man with a history of kidney transplantation and immunotherapy who was infected with COVID-19 with respiratory infections and positive RT-PCR (Real-time polymerase chain reaction). He was treated with hydroxychloroquine, Kaletra, CellCept, and prednisolone for 5 days, and finally discharged from the hospital. In addition, reviewing of 47 papers with 851 samples showed that immunosuppressant medications alone could be a therapeutic choice in kidney transplants infected with COVID-19 with careful management.

Patients with organ transplantation infected with COVID-19 may show different clinical signs, clinical course, and prognosis due to underlying diseases and the use of immunosuppressant medications. It might be best to continue taking the immunosuppressant medications but modify them based on the patients' conditions such as clinical symptoms, laboratory results, paraclinical examinations.

Evaluation of protease inhibitors (PIs) is important in terms of prescribing an effective regimen for reducing mortality and hospitalization in Covid-19. Therefore, follow- up of patients better determines the characteristics of existing regimens.

We retrospectively evaluated the demographic, co-morbidities, gastrointestinal (GI) and liver complications of patients at two teaching hospitals from the first of March to the end of July 2020. All patients received one of two recommended regimens including hydroxychloroquine (HCQ) (400 mg BD on the first day and then 200 mg BD) plus atazanavir/ritonavir (ATV) (300/100 mg daily) or HCQ with the same dose plus lopinavir/ritonavir (Kaletra) (400/100 mg BD) for 5-7 days.

We chose 170 cases that received 2 different regimens. In group one, 85(57.6% males) patients received Kaletra and HCQ and group two, 85 (55.3% males) patients received ATV and HCQ. The study of hospitalization in both groups showed no difference in more or less than 5 days hospitalization. (P=0.757) Comparison of mortality rates has not shown a significant difference including 19 (22.4%) deaths in group 1 and 15(17.6%) deaths in group 2 (P=0.443). Nausea followed by diarrhea was the most common side effects in group 1. But no side effects were reported in group 2 (P=0.000). Abnormal liver function tests (LFTs) were seen in both groups.

Comparison of hospitalization and mortality were not statistically significant. It seems that a respect to similar effect on mortality and hospitalization. ATV regimen is superior to Kaletra especially for better GI tolerance and less daily pills.

The ocular symptoms are common manifestations in coronavirus infectious disease 2019 (COVID-19), which faces secondary complications and therapeutic challenges. Underlying diseases actuate the body to infectious diseases and their related manifestations through the aberration of metabolism and suppressing the immune system. This study aimed to investigate the correlation of underlying diseases and ocular manifestations in COVID- 19 patients.

This cross-sectional study was held on 108 hospitalized COVID-19 patients (confirmed by molecular detection) admitted to Rouhani hospital, Babol, Iran. Upon hospitalization, all clinical symptoms and underlying diseases were registered. Detailed clinical examinations regarding ophthalmological protocols were used to investigate the ocular symptoms. All analyses were performed by SPSS, version 25.

Our results showed that 26.67% of patients with at least one ocular symptom had hyperlipidemia, while 10.42% of patients without any ocular symptoms had hyperlipidemia (P=0.049). In this study, 97.81% of COVID-19 patients without epiphora had no thyroid disorders (hyper-/hypo-thyroidism), while 82.35% of COVID-19 patients with epiphora had not any thyroid disorders (P=0.012). Also, 75.00% of patients with blurred vision had diabetes mellitus, while 35.00% of patients without blurred vision suffered from diabetes mellitus. This difference was borderline significant (P=0.051). Other results showed that 13.04% of COVID-19 patients with eye redness suffer from myalgia, while 35.29% of patients without eye redness had myalgia (P=0.044). Also, 35.11% of COVID-19 patients without photophobia had myalgia, while none of the patients with photophobia had myalgia (P=0.005). Finally, 70.00% of patients with respiratory distress had at least one ocular symptom, while 43.10% of patients without respiratory distress had at least one ocular symptom (P=0.007).

Some underlying diseases, e.g., hyperlipidemia, diabetes mellitus, and thyroid disorders, and some clinical symptoms in hospitalized patients, e.g., myalgia and respiratory distress, are correlated with ocular manifestations in COVID-19 patients.

When the first wave of COVID-19 outbreak occurred, the infrastructure for definitive detection of the disease through real-time polymerase chain reaction (RT-PCR) was not yet available in many regions, and a large proportion of suspected patients were inevitably referred to radiology centers to provide a chest CT scan. This research was conducted to describe chest CT characteristics in patients who underwent chest CT during the first weeks of COVID-19 outbreak in Babol, Iran.

All non-hospitalized suspected COVID-19 patients referred to the state radiologic clinic to perform chest CT from March 8, 2020 to March 28, 2020 have been enrolled in this observational study. All CT scans were reviewed by a faculty member radiologist with approximately 20 years of experience.

Totally, 2,207 (52.3%) men and 2016 (47.7%) women have been examined. Imaging characteristics in 2292 (54.3%) individuals illustrated a highly suggestive sign of COVID-19 infection while 1869 (44.3%) had a normal chest CT scan. 1813 cases (77.00%) had bilateral involvement and 541 cases (23.00%) were infected unilaterally; Also, 1727 (73.36%) patients had left-sided involvement. Lung field involvement in 2036 (86.49%) patients was less than 20%. Ground glass opacity had a sensitivity, specificity, PPV, NPV, LR+ and LR- of 99%, 96%, 96%, 98%, 22 and 0.01, respectively, for categorization of a patient as a COVID-19 case. These values were 99%, 73%, 70%, 99%, 3.72% and 0.01%, respectively for consolidations.

Although, RT-PCR is still introduced as the gold standard method for definite diagnosis, diagnostic accuracy of chest CT in COVID-19 detection is considerable.

The New coronavirus (SARS COV-2) can cause acute respiratory disease and also multiorgan dysfunction. There is insufficient data about kidney involvement in children. So, this study was done on children with COVID-19 to evaluate nephrological involvement.

All children with confirmed or suspected COVID-19 who were admitted in Children Hospital .were enrolled. They were admitted in hospital from March 2020 to July 2020. Serum Blood Urea Nitrogen (BUN), creatinine, sodium, potassium, calcium and urinalysis were evaluated. Also, glomerular filtration rate (GFR) was calculated by Schertz's formula. All patients were evaluated by chest x-ray and/or computerized tomography scanning (CTS). The data were analyzed by SPSS software and P value less than 0.05 was determined as significant.

Forty-seven children with confirmed or suspected COVID-19 were enrolled to this study. At admission, 23.4% and 27.7% of children with COVID-19 infection had abnormal increase in serum BUN and creatinine, respectively. Also 78.8% and 25.5% of children had GFR less than 90 and 60 ml/min /1.732, respectively. Additionally, 13/47 (27.7%) of children had abnormal urine analysis (microscopic hematuria and/or proteinuria). There wasn’t a significant relationship between pulmonary lesions and abnormal reduction of GFR (P<0/05).

In the study, the risk of AKI (acute kidney injury) and decrease of GFR and also abnormal urinalysis is high in children with COVID-19. So, more attention for detection of kidney involvement is necessary and more conservative management for prevention of AKI and decrease of GFR are recommended.

To assess the influence of the COVID-19 (Coronavirus Disease 2019) pandemic on treatment adherence by patients with CHF (Chronic heart failure) and to determine the factors associated with changing adherence during home-isolation.

The survey was conducted in patients participating in the COMPLIANCE study (ClinicalTrials.gov. NCT04262583). Thirty-one patients, included into in the COMPLIANCE study before March 1, 2020, were interviewed through phone calls. A modified adherence scale of the National Society for Evidence-Based Pharmacotherapy was used, which permits to assess of overall adherence, adherence to particular drugs and the main causes for non-adherence.

In the whole group of patients, only a tendency to reduced overall adherence was registered during the COVID-19 pandemic (р=0,256). Significant differences in the rate of adherence deterioration were revealed for angiotensin-converting enzyme (ACE) inhibitors (p=0.031) and for statins (p=0.002). The reasons for non-adherence were lack of opportunity to contact with a physician, inability to perform investigations necessary for correcting prescribed pharmacotherapy, and side effects.

A tendency to deterioration of adherence to prescribed pharmacotherapy was revealed during the COVID-19 pandemic. A significant decline in adherence was registered to ACE inhibitors and statins.

SARS-CoV-2 is a pandemic coronavirus that causes the COVID-19 syndrome. In the pandemic of COVID-19 many patients were affected to new onset olfactory dysfunction. Since there is a dearth of research studies regarding the standard smell test, the present study was conducted to fill this gap.

The present retrospective cohort study was conducted on 250 clients with or without diagnosis of Covid-19 disease who referred to Covid-19 centers of North of Iran. Two groups were matched for age and sex. Data were collected by examination, demographic and clinical information questionnaire and Iranian smell diagnostic test. The binary logistic regression to estimate the odds ratio value in SPSS version 23.0 was used.

One-hundred cases (42.2%) had hyposmia and 20 cases (8.4%) were found to have anosmia. Type of covid-19 sign and symptom were statistically significant with olfactory dysfunction (41 cases, 31.8%), fever (28 cases, 21.7%), weakness and dyspnea (15 cases, 11.6%), (p=0.0001). The urban residency equal OR=6.42 (3.04-13.53) to rural residency for olfactory dysfunction (p=0.0001). Covid-19 patients’ OR=61.25 (27.36-137.11) chance to be affected by the olfactory dysfunction in compare to control group (p=0.0001). Also, with increasing age, chance of olfactory dysfunction changed from OR=0.61(1.16-0.13) to OR=1.89 (0.82-4.33). Furthermore, female chance OR=1.21 (0.72-2.03) and employee patients was OR=2.29 (1.30-4.04) to olfactory dysfunction.

Alf of the patients were affected by olfactory dysfunction. Furthermore, Covid- 19 patients, urban residency, lower age, female and employee were the prognostic factors for olfactory dysfunction. The standard olfactory tests such as IR-SIT is suggested for screening and detecting the clients probably affected by covid-19 especially in younger ages.

Despite advances in preventive measures, COVID -19 spread and mortality is continuing due to delay in timely diagnosis. This problem is partly dependent on variations in disease characteristics, distribution of risk factors particularly comorbidities and demographic characteristics of patients. This study aimed to determine the clinical presentation and associated factors of mortality in patients hospitalized with COVID -19 infection.

Patients were divided into survivor and deceased groups, and clinical and laboratory findings and factors associated with mortality between the two groups were compared by calculating odds ratio (OR) with 95% confidence interval (95% CI).

A total of 257 patients (female 45.1%) with a mean age of 59.8+15.7 years and a mean hospital stay of 4.89+3.57 days were studied. Diabetes, hypertension, cardiovascular disease and chronic renal disease (CRD) were found in 29.6%, 37.5%, 16.3% and 3.5% of all patients, respectively. Forty-one (16%) patients died. Factors such as age >50 years, coexisting CRD, serum creatinine > 2 mg/dl; SPO2 <70% lymphocytes < 20% during hospitalization were independently associated with mortality. The adjusted ORs (95% CI) were 10.08 (1.39-73); 4.51(1.15-17.61); 6 (1.14-31.5); 16.8(2.93-96.7); and 4.9(1.31-18.1), respectively. Most of the expected effective drugs were not associated with lower mortality.

These results indicate a high in-hospital mortality rate in COVID -19 patients. Some mortality factors occurring during hospitalization were reversible and could be prevented by timely diagnosis and appropriate treatment

Frequent waves of corona virus disease (COVID-19) and lack of specific drugs against that, warrant studies to reduce the morbidity and mortality of this pandemic disease. In this study, we investigated the association between influenza vaccination and the severity and outcome of COVID-19 disease in Iranian patients living in the North.

This retrospective case-control study was performed on186 patients with COVID- 19 infection between March and April, 2020. Patients with positive PCR were divided into two groups of case and control; Patients with moderate to severe and normal to mild lung involvement, respectively. The lung opacities in all of the 5 lobes were evaluated on chest CT images using a CT severity scoring system. The history of influenza vaccination during the fall of 2019-2020 was determined by a phone call. Statistical analysis was done using the chi-square test, student’s t-test, and logistic regression. The significance level was p<0.05.

The mean age of patients was 54.67±15.05years. Most patients had pulmonary manifestations including ground-glass opacity (57%), consolidation (80%) and pleural effusion (3.2%). Adjusting for age, gender, and history of underlying disease, vaccination is an effective factor in the severity of pulmonary involvement (AOR=0.39; 95%CI: (0.21, 0.73); P=0.003). Furthermore, the chance of ICU admission decreased via influenza vaccination (OR=0.21, P=0.001).

The results showed that the severity of COVID-19 pulmonary involvement and outcome as ICU admission, and severe symptoms in patients with history of influenza vaccination were significantly lower than those without history of vaccination. This strategy can be used to prevent and reduce the complications of COVID-19.

lung involvement in COVID-19 can be quantified by chest CT scan. We evaluated the triage and prognostication performance of seven proposed CT-severity score (CTSS) systems in two age groups of ≥65 and <65 years old.

Confirmed COVID-19 patients by reverse transcriptase polymerase chain reaction (RT-PCR) admitted from February 20th, 2020 to July 22nd were included in a retrospective single center study. Clinical disease severity at presentation and at peak disease severity were recorded. CT images were scored according to seven different scoring systems (CTSS1-CTSS7). The cohort was divided into two age groups of ≥65 and <65 years old. Receiver operator characteristic (ROC) curves for each age group for diagnosis of severe/critical disease on admission (for triage) were plotted. Such curves were also plotted for predicting severe/critical disease at peak disease severity (for prognostication), and critical disease at peak severity (for prognostication). Areas under the curve (AUCs), best thresholds, and corresponding sensitivities (Sens.) and specificities (Spec.) were calculated.

96 patients were included with a mean age of 63.6±17.4 years. All CTSSs in 65- year-old or more group (N=55) showed excellent performance (AUC=0.80-0.83, Sens.+Spec.= 155-162%) in triage and excellent or outstanding performance (AUC=0.81- 0.92, Sens.+Spec.= 153-177%) in prognostication. In the younger group (N=44), all CTSSs were unsatisfactory for triage (AUC=0.49-0.57) and predicting severe/critical disease (AUC=0.67-0.70), but were acceptable for predicting critical disease (AUC=0.70-0.73, Sens.+Spec.= 132-151%).

CTSS is an excellent tool in triage and prognostication in patients with COVID-19 ≥65 years old, but is of limited value in younger patients.

In December 2019, China released the first report of the coronavirus (COVID- 19). On March 11, 2020 the World Health Organization (WHO) characterized the COVID- 19 as “pandemic”. The rapid occurrence of positive cases motivated this study to examine the trend of incidence cases.

We used the data from the database of the Deputy of Health of Babol City and in Iran, the country report of definite cases of the disease that was reported to the World Health Organization had been used. This study was a cross-sectional study and the data from period of 56 weeks (from February 24, 2020 to March 20, 2021) were gathered. Descriptive analysis with SPSS20 and data classification with EXCEL2016 and Joinpoint regression with Joinpoint trend analysis software 4.9.0.0 identify the significant changes in the temporal trends of the outbreak.

In this study, 11341 patients with a mean age of 53.56 years, of whom 5865(51.5%) were males, were studied. Three waves of Covid19 were created. AWPC (average weekly percentage change) incidence rate with a slope of 2.7 was estimated for Babol and 6.2 for Iran. The incidence was higher in men in the first wave of 1887(55.6%) and so is the third 2373(50.1%), the average age in the third wave (50.92) was lower than the other waves as well.

The incidence of coronavirus in men was higher in three waves and also the incidence was increasing in younger age groups. Also, due to the observance of health protocols and quarantine during the peak in Iran and Babol, we witnessed a decrease in incidence

The present study aimed to investigate the one-year prevalence of SARS- CoV-2, common comorbidities and demographic information among negative- and positive rRT-PCR in health care workers (HCW), hospitalized and outpatients. Also, the association between SARS-CoV-2 cycle threshold (Ct) and the outcomes of patients were analyzed in Babol, northern Iran.

This large retrospective cross-sectional study was performed between March 2020 and March 2021. The records of 19232 hospitalized, outpatients and HCW suspected to COVID-19 were collected from teaching hospitals in the North of Iran.

Out of the 19232 suspected to COVID-19 patients, 7251 (37.7%) had a positive rRT-PCR result; 652 (9%), 4599 (63.4%) and 2000 (27.6%) of those were categorized as HCW, hospitalized and outpatients, respectively. Moreover, between the hospitalized and the outpatient group, 10.2 and 0.8% cases died, whereas no death cases were reported in the HCW. Furthermore, it seems that death rate was significantly different between the three groups of Ct value, the highest mortality in those with Ct between 21 and 30 (group B=7.6%) and the lowest in the group with the highest Ct (between 31 and 40 = 5.5%) (p<0.001).

In summary, 37.7% of cases were positive for SARS-CoV-2; of which, 63.4, 27.6 and 9% were hospitalized, outpatients and HCW, respectively. With regard to the mortality rate in hospitalized patients and the significant association with Ct under 20 and 30, it seems that the early detection and the initial quantification of SARS-CoV-2 in the first week of the conflict and therapeutic considerations to reduce the relative load can reduce the mortality rate.

World Health Organization (WHO) declared COVID -19 infection a global pandemic. Children have milder disease than adults but different aspects of disease in children are not fully understood.

We describe 5 pediatric patients with COVID-19 that referred to Amirkola Children’s Hospital, Babol, Iran. The youngest patient was 4 years old and the oldest was 12 years old. Three patients were males. None of the patients had a history of contacts with symptomatic patients with COVID -19. The most common symptoms included fever, cough, anorexia, weakness and diarrhea. One patient had gastrointestinal symptoms without respiratory symptoms. All patients had elevated ESR and CRP. Three of them had lymphopenia. RT-PCR was positive in all patients. Management included supportive care, antibiotics, antiviral treatment and hydroxychloroquine. All patients were discharged with good condition.

Children may have a variety of symptoms including respiratory or gastrointestinal symptoms. Mortality is rare in children and prognosis is better than the adults

Coronavirus disease 2019 (COVID-19) involves different organs and clinical presentations varying from respiratory symptoms to gastrointestinal symptoms and neurological symptoms. Another group of symptoms are psychiatric symptoms and according to a study, 53.8% of participants reported various degrees of these symptoms.

In this study, we presented six cases with sudden onset OCD or exacerbation of the previously controlled OCD concomitant with COVID-19 symptoms.

Obsessive compulsive symptoms can be the presenting manifestation of COVID-19.

The neuropsychiatric manifestations may be resulted from central nervous system (CNS) infiltration, and dysregulation of inflammatory factors autoimmune responses.

We evaluated the levels of the tumor necrosis factor-α (TNF-α), interleukin- 1β (IL-1β), and caspase-3 in the cerebrospinal fluid (CSF) and serum of COVID-19 patients to improve our knowledge about underlying mechanisms caused by this virus in central nervous system involvement.

This case series study included six COVID-19 patients from March 26, 2020, to April 17, 2020, and six healthy control patients. CSF and serum levels of TNF-α, IL-1β, and caspase-3 have been assayed using monoclonal antibodies-based ELISAs. Patients with COVID-19 had significantly higher level of IL-1β, TNF-α, and caspase-3 in serum (239.16±35.73 pg/ml, 100.50±12.49 pg/ml, 3.58±0.11pg/ml, p < 0.001) and CSF (146.66±17.55 pg/ml, 63.16±14.68 pg/ml,3.22±0.03pg/ml, p<0.001), respectively as compared to control. In addition, our results showed that these biomarkers were significantly higher in serum compared with CSF of the COVID-19 patients (p<0.001).

This study provides essential information for understanding the pathogenesis of COVID-19 infection and sheds light on the potential mechanisms of virus transmission. The obtained data could be useful for designing new prevention and treatment strategies for COVID-19.

In COVID-19 pneumonia, chest CT scan plays a crucial role in diagnosing and closely monitoring lung parenchyma. The main reportedly chest CT features of novel coronavirus pneumonia (NCP) have been fully discussed in the literature, but there is still a paucity of reports on uncommon CT manifestations.

Herewith, we have reported ten rRT-PCR confirmed COVID-19 patients with CT target signs (bull’s eye appearance); additionally, we have reviewed previously reported cases. Reviewing the literature, we found eight COVID-19 patients with target sign in the literature. 18 patients were included with a median age of 43. 11 (61%) patients were males. In 87% of patients, the lesions developed within the second-week post symptom onset. These patients mostly experienced an extended hospital stay (median = 10 days), with 53.8% of cases being admitted in ICU. The in-hospital mortality rate was 23%.

Our findings indicate that lesions with a bull’s eye appearance are not significantly associated with higher mortality in hospitalized COVID-19 patients.

The most common causes of immunodeficiency are iatrogenic and the result of the widespread use of therapies which modulates the immune system, whether they are planned or haphazardly. Mucormycosis is an invasive fungal disease which is usually secondary to immunosuppression, diabetic ketoacidosis, and long-term use of antibiotics, corticosteroids, and cytotoxic drugs. There are researches which show patients with coronavirus disease 2019 (COVID-19), especially severely ill or immunocompromised, are more likely to suffer from invasive fungal infections. Patients with diabetes are at a higher risk for severe COVID-19 outcomes. However, there has been no clear evidence on the relationship between pre-diabetes state and mucormycosis as a complication of SARS-CoV- 2 infection so far.

Here, we report a case of sino-orbital mucormycosis in a pre-diabetic 54-year-old female without any underlying diseases. The patient suffered from COVID-19 pneumonia. She received 8 mg dexamethasone for 12 days. Afterwards, she returned three days after her discharge with a complaint of pre-orbital cellulitis, unilateral facial numbness and decreased visual acuity. Therefore, after primary diagnostic imaging, she was regarded as a candidate for invasive surgical intervention and was consequently treated with a combination of liposomal amphotericin B, radical recurrent surgery and posaconazole.

It is very important to consider patients who are in the pre-diabetic state or possibly immunocompromised before prescribing steroids. The patients should be examined for invasive fungal infections in post-discharge period.

Cervical carotid dissection is one of the causes of ischemic stroke in young people. Most of the patients with carotid dissection do not have connective tissue diseases (Marfan syndrome, Ehlers-Danlos syndrome). It seems that dissection may occur without an obvious cause or may follow environmental injuries like vigorous neck movements, chiropractic manipulation, emesis, severe coughs, and some infections. We present a case of bilateral carotid dissection in a patient following coronavirus infection and severe coughs.

A 38-year-old right-handed man presented with recurrent episodes of transient right hemiparesis and aphasia. He had a history of coronavirus infection and severe persistent, nonproductive cough 7 days before the onset of his symptoms. Carotid angiography showed tapered flame-like appearance in proximal segment of left ICA starting about 2 cm distal to the carotid bulb caused complete occlusion of left ICA and in right CCA angiography there is pseudo aneurysm in right cervical ICA just before the Petrous segment. In 3 months in follow up DSA there is evidence of complete occlusion of right pseudo aneurysm and recanalization of left ICA without stenosis.

COVID-19 may have role in the processes that eventually led to CAD

Coronavirus disease 2019 (COVID-19), the third coronavirus epidemic outbreak, has brought about a lot of concern about the pregnancy and the disease course, fatality rate, and the best management in severe cases. Early April 27, 2020, the first maternal mortality due to progressive COVID-19 infection was reported. Considering this challenging situation, the need for some comprehensive data on the main risk and predictive factors of disease progression is clear.

Here, we present our experience with 4 confirmed pregnant cases of COVID-19 in the second trimester, who showed typical COVID-19 symptoms like fever, cough, and myalgia. We aim to compare our findings with prior reports by reviewing the most recent and relevant studies.4 cases of COVID-19 induced respiratory discomfort in the second trimester of pregnancy were admitted to the intensive care unit. Most of the cases showed respiratory failure that led to intubation, but despite the similar initial presentation, they revealed widely. All of the required medical records are described here.

Considering the limited information on this new COVID-19 clinical courses in pregnancy in comparison with two prior coronavirus outbreaks since the early 21 century, SARS-Cov and MERS-Cov, the possibility of poor pregnancy outcome has been confirmed, but there is debate on the effect of pregnancy and different management on disease progression. Taking into account the avail of this finding, our experiences, against prior belief, suggest pregnant patients are susceptible to severe morbidity and mortality, similar to report on pregnancies with SARS and MERS.

Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has spread globally becoming a pandemic. The clinical manifestations of COVID-19 vary from asymptomatic to symptomatic disease. Hematologic manifestation which is commonly found in COVID-19 patients is thrombocytopenia whereas thrombocytosis is rarely reported.

We report a case of a 55-year-old woman with one week history of fever which spike along the day, dry cough, anosmia, nausea, epigastric pain and loss of appetite. She lived in local transmission area. The patient was diagnosed as mild suspected COVID- 19 and confirmed with nasopharyngeal and oropharyngeal swab test (positive result). On admission, the number of platelet count was within normal limit but progressively increased exceeding 1000 x109/L accompanied by worsening of the clinical condition. Interestingly, to our knowledge, no such case has ever been reported. In this study, we will discuss the possible mechanisms of its changes.

COVID-19 can present with extreme thrombocytosis. Thus, monitoring the platelet count during hospitalization can be helpful for anticipating worsening conditions and progression of COVID-19.

The effects of COVID-19 and its connection with pregnant women and infants have received growing attention of neonatal specialists and gynecologists. COVID-19 causes mild upper respiratory infections, leading to severe illness in patients with defective immune systems. In pregnant women with COVID-19 due to the adverse effects of this disease maintaining maternal health and preventing fetal death is essential and vital. The aim of this study is to report an unusual observation of Termination of pregnancy due to COVID-19 induced damage to the placenta.

A 33-year-old female patient with a gestational age of 33 weeks. The main symptoms and main concerns of the patient were shortness of breath and cough. Following positive PCR test results and CT, the COVID-19 diagnosis was confirmed. Due to the positive OCT and fetal heart failure, it was decided to terminate pregnancy and thus the patient underwent emergency Cesarean section and the infant was born weighing 2700 g and Apgar 10.

Common manifestations of COVID-19 in pregnant women include fever, cough, and muscle pain. The most common laboratory results are decreased blood lymphocytes and increased blood CRP. Pregnancy and childbirth complications in pregnant women with COVID-19 included elevated preterm delivery, increased Cesarean section rate, and infant mortality. As a result, pregnant women with COVID-19 should immediately have an ultrasound to diagnose placental thrombosis.

Rare cases of acquired thrombotic thrombocytopenic purpura (aTTP) have been reported since the administration of the COVID-19 vaccination. Based on our information, the present study provides the first case report of aTTP developed after the COVID-19 vaccination in Iran.

A 22‐year‐old Iranian woman presented with symptoms of ataxia, dysphasia, paresthesia, and acute numbness of her left upper limb four weeks after the AstraZeneca COVID-19 vaccination. Laboratory data suggested hemolytic anemia and thrombocytopenia. Also, schistocytes were noted on her peripheral blood smear. Acquired thrombotic thrombocytopenic purpura (aTTP) was diagnosed in accordance with clinical manifestations along with initial blood test results and was confirmed later through findings of ADAMTS-13 low level activity and the ADAMTS-13 positive inhibitor. She underwent 22 sessions of plasma exchange, receiving corticosteroid and rituximab. Finally, the treatment was successful.

Despite the presence of rare complications such as aTTP, vaccination is one of the best ways to prevent COVID-19 disease. The present case report describes the potential, but unproven, role of the AstraZeneca COVID-19 vaccine in aTTP pathogenesis. Vaccine- associated aTTP can be successfully treated with plasma exchange, corticosteroids, and rituximab.

There have been several studies describing clinicoradiological features of the novel coronavirus SARS-CoV-2 infection. It seems that we still should know more about pathological features in the different stages of this infection.

A 77 year-old man with cough and respiratory distress was admitted to the intensive care unit. Real-time PCR on nasopharyngeal swab was done for him and it was positive for SARS-CoV-2.He was treated with oxygen therapy, hydroxychloroquine and antibiotic therapy and was discharged from the hospital with brief improvement of clinical symptoms. However, due to persistent dyspnea, the patient was admitted to the hospital again and throracotomy and wedge biopsy were performed for about 3 months from the onset of symptoms.

Pathological examination revealed diffuse alveolar damage, fibroblastic hyperplasia, infiltration of inflammatory cells and hyaline membrane formation.

Fungal infections of the paranasal sinus are increasingly recognized in both normal and immunocompromised individuals. It is necessary to distinguish invasive diseases from the non- invasive as the result and prognosis of sinus treatment different in each one. CBCT imaging could help us in this regard. In this case, we describe a fungal sinusitis according to Cone Beam Computed Tomography (CBCT) findings.

We present a case of a 48-year-old woman with diabetes mellitus referred to our Maxillofacial Radiology Center in Babol, Iran. The patient has been discharged from the hospital recently after recovering from COVID-19 Considering the background systemic disease (diabetes) and clinical and radiological findings (extension of bone destruction), fungal sinusitis (invasive form) was listed top in the differential diagnosis list , as it is the most common condition in post-COVID-19 patients.

CBCT images are very useful for diagnosing normal anatomy variations and sinus lesions especially bone lesions .In this case, its early diagnosis led to rapid recovery of the patient