Acta Medica Iranica
Volume:60 Issue: 6, Jun 2022

The emerging disease of COVID-19 was announced as a pandemic in 2020, with wide prevalence worldwide. After the duration of the pandemic of the disease, reports based on the invasion of Aspergillus into patients' lungs with COVID-19 and their hospitalization in ICU were published by the researchers, which attracted the attention of other researchers to perform such studies. In this review, PubMed, ScienceDirect, Scopus, Springer, Wiley, ProQuest, Sid, Cochrane, and the search engine Google Scholar were searched for publications by the keywords include COVID-19, Aspergillus, SARS-CoV-2, Invasive pulmonary aspergillosis, fungal and viral co-infection or a combination of them. The data were extracted and descriptively discussed. Not many studies have been performed on the association between aspergillosis and COVID-19. However, although the results of the studies suggest some possible causes of these concomitant infections like underlying diseases and prolonged mechanical ventilation, they also recommend further studies. Since the diagnosis of common fungal and viral infections is difficult, the concurrent incidence of these two infections in patients becomes a therapeutic challenge. Accordingly, this issue increased the mortality rate in this group of patients, especially in those hospitalized in ICU. According to the recently performed studies, various problems, including underlying diseases and difficult diagnostic methods of some dangerous diseases like invasive aspergillosis, are discussed in patients with COVID-19.

Solid-organ transplantation recipients were assumed highly vulnerable to coronavirus disease 2019 (COVID-19). However, the results of previous studies in patients with orthotopic heart transplantation (OHT) under immunosuppressive therapy are contradictory. Therefore, we aimed to assess the prevalence of COVID-19 infection and associated risk factors, along with the six-month outcomes in COVID-19 positive OHT patients. This single-center telephone-based survey was conducted on OHT patients. Using a detailed questionnaire, exposure to COVID-19, related symptoms, and preventive self-care measures were collected. Outcomes of COVID-19-positive patients were reassessed using another survey six months later. 118 OHT patients (male: n=87, 73.7%) were included with a mean age of 45.3±13.1 years. Sixteen patients (13.5%) reported one or more symptoms compatible with COVID-19, of whom 12 (10.2%) tested positive. Our results indicated no statistically significant association between COVID-19 and comorbidities. Poor adherence to self-care measures and contact with positive index cases were both significantly associated with COVID-19 infection (P<0.001). A later six months follow-up showed that two out of 12 (16.6%) COVID-19 positive OHT patients died. There was no statistically significant difference between the prevalence of COVID-19 in our patients compared to Iran’s general population (P=0.152). Non-compliance with personal protective protocols and a history of contact with COVID-19 cases were the most risk factors for COVID-19 infection in OHT patients.

Dyspnea and decreased O2 saturation are the most common causes of hospitalization in noncritical COVID-19 patients. Breathing exercises and chest physiotherapy are used for managing the patients. These treatments are, however, not well supported by scientific evidence. In a randomized controlled trial, 80 patients were randomly assigned to planned breathing exercises (n=40) and control groups (n=40). The participants in the intervention group were instructed to blow into a balloon five times a day while lying down. Other therapies were similar in both groups. The severity of dyspnea at rest/after activity and peripheral oxygen saturation (SpO2) with/without O2 therapy were compared between the two groups on the first, second, and third days. The study findings showed no statistically significant difference in SpO2 with/without O2 therapy on the first, second, and third days between the two groups. Although the severity of dyspnea showed no significant difference between the two groups, the mean score of dyspnea at rest (2.72±2.25 vs. 1.6±1.21, P=0.007) and after activity (4.53±2.04 vs. 3.52±1.66, P=0.017) improved in the intervention group on the third day. Balloon-blowing exercise improves dyspnea in noncritical Covid-19 patients, but it does not significantly improve oxygenation.

In renal transplant patients, increased ferritin is associated with an increased risk of cardiovascular disease, transplant rejection, and mortality. Serum ferritin elevates in renal transplant patients due to blood product transfusion, inflammation, and malignancies. Hepcidin is also a peptide hormone produced in the liver in response to anemia, hypoxia, or inflammation. The aim of this study was to investigate the relationship between ferritin, hepcidin, iron, TIBC, and serum inflammatory markers in renal transplant patients. The cross-sectional descriptive-analytical study was conducted on 60 renal transplant patients referred to Hazrat-Rasool and Imam-Ali clinics and Al-Mahdi Laboratory of Shahrekord selected by convenience sampling method. Serum ferritin, hepcidin, iron, TIBC, and inflammatory markers levels were determined by standard kits by ELISA. Data were analyzed by SPSS software. Serum iron had a significant negative correlation with erythrocyte sedimentation rate (ESR) (r= -0.418, P=0.001) and a negative correlation with C reactive protein (CRP) (r= - 0.243, P=0.061). TIBC had a significantly negative association with ferritin (r= - 0.27, P=0.037). Ferritin, hepcidin, and TIBC were not significantly correlated with inflammatory factors. The results of the study showed no significant relationship between ferritin, hepcidin, and TIBC with inflammatory factors in renal transplant patients.

Obesity/its comorbidities occasionally exist alone, but actually, this is a dynamic network of cross morbidities that are often regarded as separable entities. Obesity is nowadays viewed as an escalating risk factor for iron deficiency, and various theories have been proposed since then explaining their relation. We aimed to determine the relationship of increased body mass index (BMI) with adiponectin, leptin, and iron profile in a sample of middle-aged and older adults with and without iron deficiency anemia. An observational study was performed among 90 participants classified into three groups. Group І included healthy subjects with normal BMI; as a control. Group II included subjects with increased BMI, and group III included subjects with increased BMI and iron deficiency anemia. After overnight fasting, fasting blood glucose, triglycerides, total cholesterol, iron, total iron-binding capacity, complete blood count, serum leptin, and adiponectin were measured. There were significantly higher mean values of BMI among those with anemia, higher mean values of serum leptin, and significantly lower mean values of adiponectin. A significant positive correlation of serum leptin with BMI and a significant negative correlation of serum leptin with iron in Group III were reported. The adiponectin/leptin ratio of (0.8) was correlated with iron and homeostatic model assessment in Group III, and a ratio of (1.1) was significantly correlated with BMI and hemoglobin level in Group II. This could suggest that interventions aimed at increasing the adiponectin/leptin ratio may help in resolving anemia among obese populations by increasing their serum iron and hemoglobin.

Advances in medicine and medical technology have presented new moral challenges in terms of the management of extremely preterm infants and newborns with severe anomalies and advanced asphyxia. The aim of the present study was to examine the attitudes of health care providers and parents regarding decisions about the treatment of these neonates. The attitude of the Shia clerics is assessed in this study as well. In this qualitative content analysis research, data were collected through semi-structured interviews and focus group discussions (FGDs) with 98 participants, including physicians, nurse practitioners, medical ethicists, Shia clerics, and parents. Purposive sampling was employed by selecting those members of the community whom we thought would provide us with the best information and were also eager to participate. Data collection continued until data saturation was reached. Data analysis was carried out using conventional content analysis. Analysis of the data resulted in the extraction of 332 codes along with the following four categories: the necessity for preparation of a national guideline for the management of neonates with poor prognosis, the establishment of hospital neonatal-management committees, decision-making regarding the limits of viability, and parental support. This study affirms that the responsibility in terms of decision-making for neonates with poor prognosis lies upon hospital neonatal-management committees based on approved national guidelines such that decisions are made according to the aforementioned guidelines, Islamic moral codes, and scope of services available in medical units. This study dismisses individual decision-making and underlines the responsibility of a hospital neonatal-management committee in making decisions based on approved guidelines that conform to the regulations of national law and Islamic moral codes that determine the continuation or withdrawal of medical care and treatment of infants with a poor prognosis while bearing in mind that regulations, hospital facilities, resources, and other conditions differ in various hospitals within the country and with developed countries.

Dengue Fever (DF) incidence in Bali has been the highest in Indonesia for decades. This study describes the annual distribution of DF and analyzes its association with population density, number of rainy days, and average humidity during 2010-2018 at the district level. The choropleth maps and Poisson regression were employed to provide geographical distribution and quantify the association. The P, 95% confidence interval (CI), and Akaike Information Criterion (AIC) were adopted to assess the significance and the goodness of the association. During 2010-2018 there were 55 215 new DF cases notified. The annual incidence of dengue cases in Bali increased with IRR: 1.000186 (95% CI:1.0000183:1.000189) for every increment of population density per kilometers square and increased by  IRR: 1.01043 (95% CI: 1.01019: 1.01078) for every additional one rainy day annually. The dengue cases also increased with IRR 1.0172 (95% CI: 1.0137: 1.0208) for every 1% increase in average humidity. Population density and climate factors are positively associated with dengue cases incidence in Bali from 2010 to 2018. The results underline the urgency of integrating population dynamics and climatic determinants into the DF control program and customizing the intervention program based on local characteristics.

Plasmoacanthoma is a rare verrucous tumor classified as a form of reactive plasmacytosis. We present the first reported case of plasmoacanthoma following exposure to bacillus Calmette-Guérin (BCG) and a comprehensive review of the literature to better illustrate the patients’ characteristics and proposed risk factors, clinical features, diagnosis, treatment, and outcome of current reports. A 64-year-old female presented with a perianal hyperkeratotic plaque and diffused inflammatory macerated erosions in the intergluteal cleft and adjacent to the plaque after intravesical BCG immunotherapy. Laboratory studies disclosed systemic abnormalities and local infection or malignancies. Biopsy showed intradermal polyclonal plasma cell infiltration with acanthosis. The lesions were successfully treated with carbon dioxide laser ablation followed by the combination of pulsed dye laser and intralesional corticosteroid. Diagnosis of cutaneous reactive plasmacytosis should be confirmed by excluding the systemic causes of plasmacytosis and malignancies. It responds well to intralesional corticosteroids; however, in severe cases and large sizes, other treatments such as carbon dioxide laser ablation and pulsed dye laser should be considered as a combined therapy. Identification of causative factors is impractical while skin irritants with subsequent inflammation seem to be involved; as in the current report, BCG contact with skin initialized the pathologic process.

In contrast to epidermoid cysts of the dermis, epidermoid cysts of the kidneys are exceptional. This report explains an uncommon patient with renal epidermoid cyst who presented with flank pain and previous history of renal stones. Our patient underwent excisional resection. The histopathological evaluation discovered cyst wall covering by squamous epithelium and containing keratinous materials compatible with the epidermoid cyst. Based on pathology findings, the patient didn’t receive any more treatment. Because pathology evaluation is necessary for the diagnosis or rules out the possibility of malignancy, biopsy before surgery is advised.

Safety monitoring of COVID-19 vaccination is paramount of importance. There are limited reports of Guillain-Barré syndrome (GBS) associated with the COVID-19 vaccination. The present study reported a case of GBS following the first dose of the Oxford-AstraZeneca SARS-CoV-2 vaccine. A 32-year-old man presented a history of progressive descending weakness and autonomic features within a month after receiving the Oxford-AstraZeneca SARS-CoV-2 vaccine. The neurological examination was consistent with acute polyneuropathy. The para-clinical investigations were in favor of acute demyelinating polyneuropathy. The patient was diagnosed with GBS, and IVIG was initiated as an acute treatment, which led to significant clinical recovery. We reported a case of GBS after receiving the Oxford-AstraZeneca vaccine. However, our findings dose not conclude a causal association between GBS and COVID-19 vaccination.