Ovarian Cancer or Hydatidosis? A Case Report

Echinococcus granulosus has been described as the common etiology of hydatid cysts in many parts of the world. A 54-yr-old female with lower abdominal pain referred to Gynecology Ward of Sari Imam Khomeini Hospital, Iran in 2016. Sonography was carried out and cysts in ovaries and liver were observed. The cysts of liver seemed to be hydatidosis but physicians were suspected about ovarian cystic mass. Anti-Echinococcus antibodies (ELISA) screen was positive. The operation was done on her and treatment by albendazole started one week before surgery and continued after discharge from the hospital. Pathology confirmed hydatidosis in ovary, also patient follow-up was performed for three months by abdominal CT scan that showed peritoan full of many small hydatid cysts. Uncommon locations for constitution of hydatid cysts such as ovary and peritoan often make the diagnosis very difficult. Hydatidosis is considered in differential diagnosis of any cysts of the entire body, especially in endemic countries such as Iran

Toxoplasmic Encephalitis in an AIDS Patient with Normal CD4 Count: A Case Report

Toxoplasmic encephalitis is a common presentation of Toxoplasma gondii infection of the central nervous system in the late stage in AIDS patients. A 40 yr old female patient was admitted to Razi Hospital of Qaemshahr City in north of Iran, in Nov 2015, with complaint of headache, blurring of vision, dysarthria and acute left-side hemiplegia and right-side ptosis. Magnetic Resonance Imaging (MRI) was performed with intravenous contrast that showed a ring enhancement lesion in the right basal ganglia showing toxoplasmic encephalitis. Anti-Toxoplasma IgG was positive. HIV antibody test was positive, as well. She was treated successfully with antiparasitic and Anti-HIV drugs and eventually was discharged from hospital. T. gondii infection is commonly detected by serologic tests. Even if in this patient, brain imaging is essential for suitable diagnosis and supervision, its results are not pathognomonic

Catastrophic Candida prosthetic valve endocarditis and COVID-19 comorbidity: A rare case

Background and Purpose: Coronavirus disease 2019 (COVID-19) and Candida prostatic valve endocarditis present various clinical manifestations which may overlap;hence, discrimination between them is extremely difficult.Case report: The case was a 66-year-old man with a past medical history of mitral and aortic valves replacement one year before COVID-19 co-infection. He was admitted with fever (for 7 days), shortness of breath, cough, seizure, lethargy,headache, and 85% oxygen saturation. Transesophageal echocardiography revealed multiple large-sized, highly mobile masses on both sides of the mechanical mitral valve highly suggestive of vegetation. Chest computed tomography scanning showed simulating scattered COVID-19 peripheral ground-glass opacities confirmed by reverse-transcription polymerase chain reaction. The set of blood cultures yieldedyeast colonies that were identified as Candida tropicalis. The patient died of septic shock shortly after receiving antifungal therapy.Conclusion: This case emphasized the importance of early diagnosis andimplementation of antifungal treatment, particularly in patients with prosthetic cardiacvalves, to reduce their unfavorable outcomes in COVID-19 patient

Tuberculous Empyema Necessitatis in a 40-Year-Old Immunocompetent Male

Empyema necessitans (EN) is a kind of empyema that diffuses to extrapleural space and can involve chest pain. Tuberculosis (TB) is the most common cause of EN. This disease can be found in both immunocompromised and immunocompetent individuals but is usually seen in the immunocompromised individuals. Because of long duration and ambiguous symptoms of the disease, diagnosis can be hard. The disease can be treated both medically and surgically. Missing the disease can lead to undesirable effects on patient’s condition and health care setting. This problem can be seen in endemic area in which controlling of TB is hard. Report of the disease in local health care center for desirable treatment and health maintenance is necessary. We explained a rare case of pulmonary TB in a patient that was healthy in other fields and just showed the minimum systemic symptoms. The patient came with a mass in lower part of back of chest cage, with a mild pain. The imaging survey showed EN. Smear and Ziehl-Neelsen stains from subcutaneous aspiration were positive for TB. This case showed importance of clinical view and awareness of this silent but serious disease in endemic area especially for TB

Epidemiological and Clinical Survey of Patients with Spondylitis

Background and purpose: Spondylitis is infection of the vertebrae and the intervertebral discs. Mycobacterium Tuberculosis, Brucella, and Pyogenic bacteria are among the major causes of this disease. There are reports on the epidemiology of this disease in Mazandaran, northern Iran. Evidence suggests differences between different types of spondylitis, but there is paucity of information on the differences between all types of spondylitis, especially Pyogenic spondylitis. The aim of this study was to investigate the clinical epidemiology of spondylitis in the region to make early diagnosis and appropriate treatments. Materials and methods: A descriptive study was done using the records of patients with spondylitis in Qaemshahr Razi Hospital, 2013-2017. Information including epidemiologic and demographic characteristics, main complaints and clinical symptoms, disease complications, radiological findings, and laboratory findings were extracted. Data were analyzed in SPSS V24. Results: The records of 39 patients (19 males and 20 females) were reviewed. Among the patients Brucellar spondylitis, tuberculous spondylitis, and pyogenic spondylitis were identified in 35.9%, 38.5%, and 25.6%. Conclusion: In current study, the rate of spondylitis was higher than that in other studies, which may be due to higher rates of tuberculosis in Mazandaran. Thoracic involvement was found to be more common in tuberculosis while Brucella and pyogenic spondylitis involved lumbar vertebrae. These findings could be of great help in distinguishing between the three conditions

Relationship between CT Findings of Pulmonary Tuberculosis and Acid-Fast Bacilli Sputum Smears

Background and purpose: Computed tomography (CT) scan is of great help in confirming the diagnosis of tuberculosis (TB) before the sputum test result. The purpose of this study was to investigate the relationship between pulmonary involvement patterns in CT scans of TB patients with positive sputum smears. Materials and methods: This retrospective descriptive-analytical study was conducted using the records of TB patients admitted to Ghaemshahr Razi Hospital between 2012 and 2018. Demographic information and CT scan reports were collected and compared with the sputum smear results. Results: The records of 271 patients (185 men and 86 women) with an average age of 49.31±15.08 years were examined. Sputum smears were positive in 191 (70.5 %) patients and negative in 80 (29.5 %). The most prevalent lesions were cavitation (72.7%) and consolidation (42.8%), and the most common locations were the upper lobe of the right lung (61.3%) and the upper lobe of the left lung (53.5%). Cavitary and consolidation lesions were significantly more common in patients with smear positive TB (P<0.001). Cavity observation significantly increased as the positive smear level rose (P<0.001). Conclusion: Cavitary and consolidation lesions were more prevalent in patients with positive smears, whereas less common lesions were seen more in those with negative smears. Therefore, the pattern of lung lesions shown on the CT scan is linked to the sputum smear result

Clinical Epidemiology of Ventilator-Associated Pneumonia in Open Heart Surgery Patients Admitted to Intensive Care Units in Sari Fatemeh Zahra Hospital, 2017-2019

Background and purpose: Ventilator-associated pneumonia (VAP) is one of the major factors of mortality and morbidity in Intensive care units (ICUS), especially in open-heart surgery patients. The purpose of this study was to investigate VAP in open-heart surgery patients admitted to the ICU in Sari Fatemeh Zahra Hospital, 2017-2019. Materials and methods: In this retrospective descriptive cross-sectional study, demographic, clinical, laboratory, and therapeutic information of patients with VAP were examined. Data were analyzed using SPSS V25. Results: A total of 52 patients with VAP were elevated after open heart surgery. The mean age of patients was 64.41±10.85 years and 55.8% were men. Half of the patients (51.9%) underwent intubation for less than five days and the mean duration of occurrence of VAP after initiation of ventilation was about six hours. The most common microorganisms causing pneumonia were Acinetobacter baumannii (23.63%) and Citrobacter freundii (16.36%). In general, the highest resistance of isolated microorganisms was toward third-generation cephalosporins and their highest sensitivity was to aminoglycosides. Conclusion: Control and prevention of ventilator-associated pneumonia is of particular importance, especially in patients after open-heart surgery admitted to intensive care units

Seroepidemiologic Survey of Hepatitis A in Mazandarani Pilgrims before Going to Karbala in Arbaeen Pilgrimage in 2018

Background and purpose: Recently, due to the reduction of hepatitis A in Iran there are people with low or no Hepatitis A Virus- Antibody (HAV-Ab), therefore, people at Arbaeen Pilgrimage are at risk for hepatitis A. This study aimed at examining HAV-Ab in pilgrims traveling from Mazandaran province, Iran to Karbala in 2018. Materials and methods: This cross-sectional study was performed in 200 people selected from 40,000 pilgrims in Mazandaran province. Serum samples were evaluated for presence of HAV-Ab and data for demographic characteristics and history of hepatitis A immunity were recorded. Data analysis was performed in SPSS V16. Results: The participants were 137 (68.5%) males and 63 (31.5%) females. Positive and negative HAV-Ab were seen in 156 (78%) and 44 (22%), respectively. Mean ages of people with positive and negative HAV-Ab were almost similar (50 years and 47 years, respectively). HAV-Ab status was found to be significantly associated with job (P0.05). Conclusion: Twenty-two percent of people who were travelling to Karbala had no HAV-Ab, which is significant because the risk of developing fulminant hepatitis increases in adults, therefore, vaccination of Karbala pilgrims for hepatitis A virus is suggested

Prosthetic valve endocarditis caused by multidrug-resistant Candida albicans in a patient with myelodysplasia syndrome: A case report and literature review

Background and Purpose: Candida endocarditis is an infrequent disease with a high mortality rate, which commonly occurs in immunosuppressed patients with cardiac valve replacement. We reported a 70-year-old woman diagnosed with Candida prosthetic valve endocarditis (PVE). This study also involved a review of all published cases of Candida PVE from 1970. Case report: Herein, we reported a 70-year-old woman with the history of severe mitral stenosis and myelodysplasia syndrome. She underwent mitral valve replacement for two times. The blood cultures were positive, and phenotypic identification of the isolates at the species level was performed based on microscopic and macroscopic characteristics. In the second prosthetic valve replacement, huge fungal white and creamy vegetation was observed which was identified as Candida albicans based on the conventional and molecular methods. Despite the administration of antifungal treatments, the patient passed away probably due to the multidrug-resistant Candida PVE. Conclusion: As PVE is a late consequence of prosthetic valve replacement, extended follow-up visits, early diagnosis, repeating valve replacement surgeries, and timely selective antifungal treatments are warranted. Keywords: Amphotericin B, Antifungal resistant, Azoles, Candida endocarditis, Multi-drug resistant, Myelodysplasia syndrome, Prosthetic valve replacemen