Post‐COVID‐19 splenic infarction in a patient with chronic atrial fibrillation: A case report

Abstract We describe splenic infarction (SI), an infrequent condition, in an 82‐year‐old COVID‐19 patient with chronic atrial fibrillation (AF). COVID‐19 may cause thrombosis, and AF is a predisposing factor for splenic infarction. Suspicion of SI may be warranted in COVID‐19 patients with abdominal pain, especially if a predisposing factor exists

Comparison between Efficacy of Ciprofioxacin -Doxycycline with Rifampin – Doxycycline Regimens inrelapse of Brucellosis

Background: Brucellosis is one of the endemic diseases in Iran that has a worldwide spread and is associated with chronic disabilities in humans. Combination therapy of Brucellosis leads to recovery of symptoms, shortening of the symptomatic intervals, and decrease in the rate of relapse and drug resistance. Considering the use of rifampin in the treatment of tuberculosis, and the necessity for an alternative treatment in regions endemic for both tuberculosis and brucellosis, the aim ofthis study was to compare the efficiency of the regimen of rifampin-Doxycycline with ciprofloxacin-Doxycycline in relapse of brucellosis. Materials and methods: This randomized controlled trial was performed on 90 patients, older than 17 years old, affected with brucellosis, which were referred to the Infectious Disease Clinics at ArakUniversity of medical sciences between the years 1384-1387. The patients were randomly divided into two groups: the DR groups, receiving 100 mg of Doxycycline twice a day and 300 mg of rifampin Bid daily for eight weeks and the CD group, receiving 100 mg of Doxycycline plus 500 mg of ciprofloxacin twice a day for eight weeks. The patients were analyzed for the relief of symptoms, drug side effects, and laboratory findings during the treatment. Results:In this study, the rate of relapse in both groups were similar. The relapse was seen in 4.5% and 3.2% of the patients for the DR and CD groups, respectively (P=0.168). The drug side effects were slight in both of groups, with no significant difference, and did not lead to discontinuation of the therapy. Conclusion: According to the same rate of relapse in both CD and DR regimens in the treatment of brucellosis and considering the usage of rifampin in regions with high prevalence of tuberclusis, the CD regimen is recommended as an appropriate one

An HIV‐positive woman with massive brain lesion due to toxoplasmosis: A case report

Key Clinical Message Toxoplasmosis‐related huge brain lesions may require decompressive craniectomy and lesion excision to avoid brain damage. In this situation, injectable cotrimoxazole is a better choice for treatment. Abstract Toxoplasma gondii is a worldly distributed obligate intracellular protozoa. Toxoplasmosis is a prevalent opportunistic infection in HIV‐infected people, but it was rarely recorded prior to the identification of HIV infection. Here, we report a toxoplasmosis brain lesion in an Iranian HIV‐positive patient. A 45‐year‐old woman with a complaint of malaise was referred to the Valiasr Hospital in Arak city. In her past clinical history, the patient had a history of anemia, deep vein thrombosis (DVT), and positive HIV. The patient was informed of the diagnosis of massive brain toxoplasmosis as a definite diagnosis. The patient was then taken to the operating room for a left decompressive craniectomy, during which the ensuing brain lesion was excised. After a few days, she was discharged from the hospital in good condition and without any complications

Effect of probiotic preparation in preventing antibiotic associated diarrhea and colitis: a Clinical trial

Background: Clostridium Difficile is the most common cause of antibiotic- associated diarrhea (AAD) and antibiotic associated colitis (AAC) in the hospital setting. In this Study, the preventive effect of Lactobacillus coagulance probiotic preparation was investigated on AAD and AAC. Material and Methods: In this double blind randomized clinical trial study, 300 patients under antibiotics treatment according to our inclusion and exclusion criteria were enrolled to the study and randomly divided into two groups, case (tab probiotic, 100mg/day) and control group (placebo) from initial antibiotic administration till one week after termination of antibiotic consumption. All patients were trained about the signs of diarrhea and colitis. Colitis signs, incidence of diarrhea and its culture findings for the presence of the toxin of Clostridium difficile were recorded and compared between groups. Data were analyzed with appropriate statistical tests and using version 16 of SPSS statistical software. Results: Antibiotic associated diarrhea (AAD) was seen in 10 (6.6%) and 16 (%10.6) patients of case and control group respectively. There was no significant difference between groups in AAD incidence and positive stool exam regarding the presence of Clostridium difficile toxin. Colitis syndrome were develop in 34 (22.8%) and 86 (57%) patients of the probiotic and placebo group respectively that was significantly low in case group (p<0.001). Conclusion: There was no statistically significant difference between probiotic group and placebo group in reducing AAD. But, consumption of Lactobacillus coagulance probiotic can reduce the incidence of antibiotic associated colitis

Proposing a two-step decision support system for differential diagnosis of tuberculosis from pneumonia

Mycobacterium tuberculosis (TB) is an infectious bacterial disease presenting similar symptoms to pneumonia. Therefore, differentiating between TB and pneumonia can be challenging for physicians and lead to delays in diagnosis and treatment. Early diagnosis of TB in particular, is critical in preventing community spread. The purpose of this study is to propose a method of differential diagnosis of TB from pneumonia using low-cost features. A two-step decision support system called Pneumonia-Tuberculosis Diagnosis Support System (PTBDSS) is proposed for differential diagnosis of TB from pneumonia based on stacked ensemble classifiers. The first step of the proposed model aims to identify an early diagnosis based on low-cost features, including demographic characteristics and patient symptoms. The second step of the proposed model confirms a diagnosis based on meta features extracted in the first step, laboratory tests, and chest radiography reports. The meta feature is a vector of length five, and each number in that vector comes from the vote of one classifier. This retrospective study considers 199 medical records of patients admitted to the isolation ward of a hospital in Arak, Iran, with suspected TB or pneumonia. Experimental results show that the proposed method outperforms the compared machine learning methods for early differential diagnosis of pulmonary tuberculosis from pneumonia with AUC of 90.26±2.30 and accuracy of 91.37±2.08 with 95% CI and final decision making with AUC of 92.81±2.72 and accuracy of 93.89±2.81 with 95% CI

Transmission Electron Microscopy of XDR Mycobacterium tuberculosis Isolates Grown on High Dose of Ofloxacin

The aim of the study was to investigate behavior of resistant Mycobacterium tuberculosis (MTB) isolates under a high dose of ofloxacin and its morphological changes. 19 extensively drug resistant (XDR) clinical isolates of MTB were grown on Löwenstein–Jensen medium containing progressively increasing concentrations of ofloxacin (2, 4, 8, 16, 32 mg/L). Ultra-structure analyses of resistant isolates grown on ofloxacin were conducted by transmission electron microscopy (TEM). Fixation was carried out by 4% glutaraldehyde in 0.1 M sodium cacodylate buffer on 300 mesh carbon formvar copper grid. The samples were negatively stained with uranium acetate suspension. All19XDRMTBisolatesweregrownandformedcoloniessuccessfullyon2,4,8mg/L,sevenisolates on16mg/L,andfourisolateson32mg/Lofloxacin. Morphologicalchangesandunusualformswere detected in 8, 16 and 32 mg/L ofloxacin at 43%, 76.5% and 81% of cells, respectively. Swollen form (protoplast like), ghost-like cell, degraded forms, and in a few cases, detached cytoplasm from cell wall were clearly detected in high drug concentrations in comparison to control. Changes in morphology were increased with increasing ofloxacin concentrations (p &lt; 0.05). Some XDR isolates could be successfully grown on high doses of ofloxacin (32 mg/L), but with changes in morphology. It was concluded that several magnitudes of the drug doses could not prevent growth of drug resistant forms

Evaluation of the effect of favipiravir on patients with COVID-19

Background: The novel coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) started in December 2019 in Wuhan, China. No specific drug has been accepted for COVID-19 treatment up to now. Favipiravir as an antiviral drug affects RNA viruses like influenza and Ebola. Accordingly, the aim of this study is the evaluation of favipiravir's effect on COVID-19 outcomes. Method: This is a randomized controlled study including 97 patients with COVID-19 randomly allocated into favipiravir or control groups. The primary outcomes were improvement of clinical manifestations and atrial oxygen saturation (SpO2), and the secondary outcome was the length of hospitalization. Results: Clinical manifestations recovery of COVID-19 patients was better in the favipiravir group, and the mortality rates were less than in the control group (P = 0.0001 for both). The level of blood oxygen saturation (SpO2) was significantly higher in the favipiravir group (P = 0.0001). The mean lymphocyte count was lower in the control group (P = 0.004). In addition, levels of blood urine nitrogen (BUN) were higher in the favipiravir group (P = 0.033). The length of hospitalization was similar in both groups (P = 0.586). Conclusion: Favipiravir can be effective for clinical and laboratory improvement of COVID-19 patients, and it is a promising drug for decreasing of mortality rate in these patients