Coronavirus disease 2019 (COVID-19): What we need to know

Coronavirus disease 2019 (COVID-19): What we need to kno

Clinical diagnosis challenges in Zika virus infection

Dear Editor, Will Zika virus (ZIKV) infection as a mosquito-borne illness with symptoms similar to flu difficult to diagnose? To answer this question, we need to know this infectious disease well and its clinical symptoms. So, first we need to point to the mentioned case. ZIKV is an emerging viral infection in the Flaviviridae family, transmitted by Aedes aegypti. At present according to the reports of health organizations, this infection has spread throughout the USA, the Pacific Islands, and the Southeast Asia. This flu like infection causes mild symptoms resolved in two weeks, like fever, headache, rash, myalgia, redness, and conjunctivitis (1). Thus, the temperature is usually low grade fever (within 38.0°C) and skin rashes are likely immune-mediated and pruritic in many cases which begin within 1–4 days onset. Definitely, the complicated features comprising Guillain-Barré syndrome (GBS) and fatal encephalitis in adults, an abnormally small head size (microcephaly) in newborn infants, immune thrombocytopenic purpura (ITP) were documented (2). There are many flu like illnesses, which may make clinicians doubtful in the diagnosis of ZIKV infection. Among these diseases can be referred to such terms as herpes simplex virus (HSV), acquired immune deficiency syndrome (HIV/AIDS), hepatitis C, Lyme disease, Q fever, dengue fever (DF), measles, and so on. In other words, it is confirmed that these common clinical presentations of ZIKV infection performed to be very similar to some arboviral diseases, like as Chikungunya virus (CHIKV) and Dengue virus (DENV) infection, as a result, a confounding diagnosis. Consequently, a study that was conducted in 2015 revealed 224 dengue cases screened for ZIKV infection, seven patients had positive results for ZIKV infection(3). Several in vitro studies suggested cross-reactivity between antibody responses in dengue virus (DENV) as an arthropod‑borne virus and a member of the genus Flavivirus, and Zika virus(4). Even few research studies suggest that dengue virus enters to cells with Tyro 3, Axl, and Mertk (TAM) and T-cell immunoglobulin and mucin domain (TIM), and these receptors are engaged in ZIKV infection (5). Although other studies showed the differences between these infections that they are very helpful in solving the misdiagnosed problem. Rashes in ZIKV infection are more likely to occur in the first week than dengue infection. In the event, rashes regularly appear during recovery phases of dengue disease. Contrary to dengue, hemorrhagic episodes and abnormality in laboratory findings as thrombocytopenia occur less frequently in ZIKV. It has shown that different types of edema are more common in ZIKV infections than in DENV illness. In general, people with ZIKV infection, unlike dengue fever, less likely develop severe illnesses and need to be hospitalized. As a consequence, it can be concluded that diagnosis of ZIKV infection and the complete and accurate verification is a great challenge due to low-level viremia and cross- reactivity related to immune system functions. On the other hand, detection of this infection is best during the early-phase, though, diagnosis is seriously problematic at this stage because the disease occurs in this phase asymptomatically (3). As a result, the best and the most reliable things are the careful evaluation of infection regarding clinical and paraclinical (hematologic) parameters alongside the use of RT-PCR with high specificity and sensitivity as the gold standard for ZIKV detection. Meanwhile, RT-PCR is effective in serum, saliva and semen in 1-2 weeks post infection. Moreover, it is recommended to use acute and recuperating samples for better diagnosis (5). The use of molecular tests such as Trioplex Real-Time RT-PCR (rRT-PCR) by the Centers for Disease Control and Prevention (CDC) is recommended specially for those who have recently traveled to regions with risk of Zika and even show some symptoms of a disease such as Chikungunya virus (CHIKV) and DENV(5)

Performance of the 4th Scientific Olympiad of Medical Students of the Universities of Medical Sciences in Iran about Empowerment and Loyalty

Background & Objective: Scientific Olympiads are planned to identify creative, innovative, and the most talented students. These competitions create cheerful environments in order to increase the capabilities and motivation of the students. Satisfaction and loyalty of the participants are suitable characteristics to evaluate the efficacy of an Olympiad. This study was performed to evaluate the success rate of the 4th Scientific Olympiad of Medical Students of Iran about empowerment and loyalty in the participants’ viewpoints. Methods: This cross-sectional study was conducted in 2012-13 on the participants of the 4th Medolympiad of Iran. The research sample was selected by census. Data collection was performed by a researcher-made questionnaire, the validity and reliability of which were confirmed. The data were analyzed using SPSS software at significant level of < 0.05. Results: Among the 320 participants from 4 groups, 62 students (27%) were in the domain of basic science, 50 students (22%) in clinical reasoning, 56 students (24%) in health management, and 61 students (27%) in innovation. The mean score of preparation in the Universities of Medical Sciences was 2.5 ± 1.1 (out of the total score of 5). The 4th Medolympiad gained a score of 3.2 ± 1.1 out of 5 in personal empowerment and 3.7 ± 1.2 out of 5 in loyalty. There was a significant correlation between the level of preparation in Medical Universities and the type of university (P < 0.001). There was a significant correlation between the level of loyalty and the type of university (P < 0.001). Moreover, there was a significant correlation between the level of loyalty and academic degree of students (P = 0.029). Conclusion: The success rate of the 4th Medolympiad in terms of empowerment and loyalty of students was higher than the moderate level; therefore, it is necessary to improve the subsequent periods. Keywords Olympiad Academic competitions Talented education Medical student Empowerment Loyalt

The Satisfaction Level of Participants of the 5th Medical Students' Scientific Olympiad in Iran in 2013

Background & Objective: It is attempted to identify creative and talented individuals and to ensure the satisfaction of volunteers through creating a joyful atmosphere in scientific Olympiads. The aim of the present study was to assess the level of satisfaction of candidates with the quality of the 5th National Medical Sciences Olympiad in Iran. Methods: This cross-sectional study was conducted in the summer of 2013. The study population consisted of the candidates of the 5th National Medical Sciences Olympiad among the medical universities of Iran. The subjects were selected through census method. The data collection tool was a questionnaire designed by the researcher and its validity and reliability were confirmed. Data were analyzed using SPSS software at a significance level of P < 0.050. Results: Of the 222 studied candidates around the country, 67 individuals (30.2%) studied Basic Sciences, 52 (23.4%) Clinical Reasoning, 67 (30.2%) Management of Health Systems, and 36 (16.2%) Art in Medical Education. The mean satisfaction level of candidates with the quality of this national Olympiad was 3.2 ± 1.1, and with the content and functionality of this Olympiad was 3.3 ± 1.2. There was a significant relationship between gender and satisfaction with the quality of the Olympiad (P = 0.002). There was a significant relationship between age (P = 0. 010, r = 0. 131), semester (P = 0. 019, r = 0.122), and academic type (P = 0. 019) and satisfaction with content and functionality of this Olympiad. Conclusion: Satisfaction with quality, content, and functionality of the 5th Olympiad was at a moderate level, and thus, requires improvements. Key Words: Satisfaction, Scientific Olympiad, Talent, 5th Olympiad, Medical student

Spontaneous relapse in patients with inactive chronic hepatitis B virus infection

Background: Chronic hepatitis B virus infection (HBV) may reactivate during the course of the disease and is called spontaneous relapse. The purpose of this study was to evaluate the incidence of relapse of hepatitis in subjects with inactive HBV carriers. Methods: This follow-up study was performed on 785 patients with inactive HBV carriers that were followed-up at six month intervals. The presence of serum HBsAg and anti-HBe, without HBeAg, HBV DNA levels <2000 IU/ml with normal alanine aminotransferase (ALT) levels was defined as inactive carriers. Patients who developed ALT ≥80 IU/L with HBV DNA levels ≥2000 IU/ml were considered as spontaneous relapse. Results: Seven hundred- eighty five cases (441 males, 344 females) of chronic HBV infected individuals were followed-up. The mean age at the entrance of the study was 30.5±11.8 years. The mean follow-up duration was 5.9±5 years. Relapse was seen in 35 (4.5%) cases, in 27 out of 441 (6.1%) males and in 8 out of 344 (2.3%) females and in 4.2% subjects ≥30 years versus in 4.7% cases of under 30 years (p>0.05). The development of relapse in males was higher than females (hazard ratio 2.53, 95% CI 1.2-5.6, p=0.021), but age ≥30 or <30 years did not have effect (hazard ratio1.21, 95% CI 0.62-2.36, p=0.58). Conclusions: The results show that spontaneous relapse of hepatitis may develop during the course of chronic HBV infection. We suggest that all patients with chronic hepatitis B, regardless of their age, be examined for the possibility of relapse

Ten-year data analysis of digestive system malignancies at Babol, north of Iran: 2008-2017

Background: Unlike some regions of the world where digestive system cancers are not considered as important health problems, these neoplasms are among the most common malignancies in the northern region of Iran. Methods: This observational analytical study was carried out based on data collected by the Cancer Registration Center affiliated to the Vice Chancellery for Health of Babol University of Medical Sciences, North of Iran, during 2008-2017. Crude incidence rate (CR), and age-standardized incidence rate (ASR) have been calculated for different GI cancers, based on the primary involved site; and have been compared in different years, patients&#39; age, gender and place of residence. Results: Totally, 4332 records were related to digestive system cancers. Mean age of patients was 63.48&#177;14.73 years; men (2743; 63.3) were more affected than women (1589; 36.7) (p&#60;0.001). The most incident malignancies of digestive system were from stomach, colorectal and esophagus in men; and colorectal, stomach and esophagus in women, respectively. These three cancers accounted for 3725 (85.98) of total GI malignancies. The mean age of patients in various types of GI cancers was statistically different (p&#60;0.001). Age- standardized incidence rate showed different values in different years; from 521.40 (95 CI: 462.79-580.00) in year 2016 to 1834.33 (95 CI: 1637.36-2031.29) in year 2008. Conclusion: Gastric, esophageal and colorectal cancers were the most prevalent digestive system malignancies in Babol, North of Iran, and accounted for about 86 of all GI tract cancers. A considerable variation has been found in incident gastrointestinal cancers in different years

Clinical and laboratory findings of patients with the possible diagnosis of influenza hospitalized in affiliated hospitals of Babol University of Medical Sciences, 2015-2016

The clinical and para clinical manifestations of influenza in various patients have range from an autoimmune disease to a life-threatening respiratory infection. In addition, the severity of the disease is influenced by factors such as demographic factors, underlying diseases, and immune response. Therefore, in this study, we evaluated the clinical, laboratory and epidemiological characteristics of patients with this type of influenza in Babol (north of Iran). This study was conducted as a descriptive cross-sectional study from October 2015 to March 2016. Subsequently, in this study, records of 123 patients with clinical signs of the influenza-like disease who have undergone the clinical sign in hospitals affiliated to Babol University of Medical Sciences were reviewed. Of 123 patients admitted to a possible diagnosis of influenza, 58 patients (47.2%) were PCR positive for H1N1, while seventy nine (64.2%) participants were women and 21 (17.1%) had diabetes or underlying lung disease. Most of the involved age groups were of individuals above the age of 50. These were followed by the 21-35 years-old. Fever (78%), cough (65.9%), shivering (58.5%) and myalgia (56.1%) were the most common clinical symptoms. Increased levels of transaminases (43.1%), leukocytosis (35.8%) and thrombocytopenia (34.2%) were as well reported in patients as the most frequently reported para clinical findings. In the present study, the most usual clinical symptoms were fever, cough, chill, and myalgia, while gastrointestinal symptoms were also noticeably observed in patients. In an experimental study, a significant number of patients showed leukocytosis and thrombocytopenia and increased transaminases

Sever hepatitis induced by Epstein-Barr virus: case series

Epstein-Barr virus (EBV) is a causative agent of infectious mononucleosis syndrome. This infection often resolves over a period of several months without outcomes, but may occasionally be complicated by a great variety of neurologic, hepatic, hematologic and respiratory complications. In the current report, we present the case histories of three patients with acute hepatitis following EBV infection when previously healthy. The patients showed fever, nausea, weakness, as well as yellowing of the skin, and then in the course of examination, sore throat. They were managed supportively and their clinical condition improved. Liver function tests such as ALT, AST, ALP, were undertaken and bilirubin were elevated. The serological tests for EBV infection were consistent with the acute phase of infection. The monospot test was also positive. The patients were managed supportively, and their critical condition was improved