COVID-19 coinfection with Mucormycosis

Objectives: We will try to present cases of coinfection with COVID‑19 and mucormycosis in Kashan to increase the awareness of health‑care providers and reduce the number of forgotten and neglected cases.Methods: This is a descriptive cross‑sectional study that patients infected with COVID‑19 become vulnerable to a variety of opportunistic diseases. There are several studies of COVID‑19 and mucormycosis, but an effort has been made to provide a collection of cases in Kashan (the center of Iran) to reduce morbidity and mortality by increasing the awareness of health‑care providers.Results: A total of 31 patients with mucormycosis following COVID‑19 including 18 males and 13 females were included in the study. All reverse transcriptase‑polymerase chain reaction patients were positive for severe acute respiratory syndrome‑coronavirus‑2. Twenty had a history of diabetes, eight had a history of hypertension, and three had no record of any underlying disease. The maxillary sinuses were the most common site of involvement. The maximum length of hospital stay was 52 dayss.Conclusion: Patients with COVID‑19 vulnerable to comorbidities, any facial involvement, or severe glucocorticoid and antibiotic treatment should be closely examined and monitored at the first encounter and during hospitalization for any signs of mucormycosis and start standard care and antifungal treatment as soon as possible

Invasive Fusarium rhinosinusitis in COVID-19 patients: report of three cases with successful management

Invasive fungal rhinosinusitis (IFRS) is a life-threatening infection that can occur in immunocompromised patients, including those with COVID-19. Although Mucorales and Aspergillus species are the most common causes of IFRS, infections caused by other fungi such as Fusarium are rare. In this report, we present three cases of proven rhinosinusitis fusariosis that occurred during or after COVID-19 infection. The diagnosis was confirmed through microscopy, pathology, and culture, and species identification of the isolates was performed by DNA sequencing the entire ITS1-5.8 rRNA-ITS2 region and translation elongation factor 1-alpha (TEF-1α). Antifungal susceptibility testing was conducted according to CLSI guidelines. The causative agents were identified as Fusarium proliferatum, F. oxysporum + Aspergillus flavus, and F. solani/falciforme. Treatment involved the administration of antifungal medication and endoscopic sinus surgery to remove the affected mucosa, leading to the successful resolution of the infections. However, one patient experienced a recurrence of IFRS caused by A. flavus 15 months later. Early diagnosis and timely medical and surgical treatment are crucial in reducing mortality rates associated with invasive fusariosis. Additionally, the cautious use of corticosteroids in COVID-19 patients is highly recommended

Standardization of Morning Reports in Internal Medicine Department at Kashan University of Medical Sciences

Introduction: Morning report is one of the most effective methods in clinical education. The purpose of this paper was to assess the current state of morning report in the Department of Internal Medicine at Kashan University of Medical Sciences in order to identify the weaknesses and standardize this important educational procedure. Methods: This quasi-experimental study was conducted in Department of Internal Medicine at Kashan University of Medical Sciences in 2016. Data were collected by a researcher-made questionnaire based on the clinical education standards developed by the Ministry of Health and Medical Education, Deputy of Education. First, the weaknesses were identified in the morning report sessions by surveying the stagers, interns and residents selected by means of census method from all of the internal medicine learners (15 stagers, 6 interns, and 9 residents). Then, faculty members were lectured on the correct way of holding morning report session. After the trainings, the participants were resurveyed using the same questionnaire and the extent of changes in complying with the educational standards was measured. The data were analyzed by Chi-square test and Fisher’s exact test. Results: The standards with significant increase in full compliance after the intervention were as follows: complete observation of “step-by-step discussion” (p<0.001), “differential diagnosis” (p=0.001), “discussion of diagnostic tests” (p<0.001), “discussion of systematic approach” (p=0.005), “discussion of radiology images” (p=0.002), “provision of appropriate conditions for teacher-learner interactions” (p=0.004), “attention to learners’ attendance” (p=0.001), and “teacher-learner eye-contact” (p=0.024). Conclusion: The training of the internal medicine faculty members in morning report had a positive effect on the standardization, and the quality of education and its compliance with the standards may be improved by continuous trainings

Common Infectious Diseases Among the Hospitalized Elderly Patients

Objectives: The elderly are more susceptible to the infectious diseaseswith higher risk of morbidity and mortality. Variouspresentations of infectious disease in the elderly can lead to delay in diagnosis. This study aimed to evaluate the clinical featuresof infectious diseases and laboratory findings among the hospitalized elderly patients. Methods & Materials: In a cross sectional study, 248 older people admitted to Beheshti hospital of kashan, Iran, during the year 2009, with an infectious disease were recruited. The patient was diagnosed with an infection if fever or a local site of infection was present. After history taking and physical examination, laboratory tests including blood culture, urine culture, CBC, ESR, and CRP and diagnostic imagings such as sonography, CT scan and MRI were performed. Demographic information, clinical findings and laboratory tests results were recorded through interviews, as well as review of medical records. The results are presented by descriptive statistics. Results: Among a total of 248 patients with mean age of 74. 3 years old, 133(53.6%) were male. Most of the patients (78.4%) aged 60-75 years old. The most common chief complaint was fever (19.4%) followed by dyspnea (14.9%) and the most common underlying disease was hypertension (37%). Pneumonia was the most common infectious disease (23.4%) followed by Spiss (15.7%). a total of 117(47.2%) patients had a previous history of hospitalization. Conclusion: The most common infectious diseases leading to hospitalization and death in the elderly arepneumonia and sepsis

Candidemia in patients with prolonged fever in Kashan, Iran

Background and Purpose: Candida species are considered a common cause of fungal blood stream infections, which are associated with considerable mortality and morbidity rates, especially in the admitted and immunocompromised patients. Despite the increase in new and available antifungal agents, the emergence of resistant strains is growing. Regarding this, the aim of the present study was to assess the fungal epide&shy;miology of candidemia and the antifungal susceptibility patterns against five current antifungal agents among the patients with prolonged fever, who were admitted to Beheshti Educational Hospital, Kashan, Iran. Materials and Methods: This cross-sectional study was conducted on 253 hospitalized patients with prolonged fever despite receiving broad-spectrum antibiotic therapy. Blood samples were collected aseptically, and then cultured using an automated blood culture system and conventional broth culture bottle. Candida isolates were identified at species level using morphological and physiological properties and produced color on the CHROMagar Candida. Furthermore, the antifungal susceptibility testing was performed using (CLSI M27-A3 and CLSI M27-S4) broth microdilution methods. Results: The most positive cultures were detected by the automated blood culture system. C. albicans (%50) was the most prevalent species, followed by C. glabrata (%40), and C. parapsilosis, (%10)&nbsp; respectively .The mortality rate was high (%60) and most patients with candidemia were admitted to the Intensive Care Unit and Neonatal Intensive Care Unit. All isolates were susceptible to amphotericin B, while the highest resistance belonged to caspofungin. Conclusion: In this study, high resistance was reported, especially for caspofungin, which can be regarded as the emergence of caspofungin-resistant strains. Regarding this, the establishment of a surveillance and prevention program for the reduction of the emergence of resistant species is necessary

Evaluation of Educational Departments of Kashan Shahid Beheshti Teaching Hospital

Introduction: Medical education quality improvement is a major issue in Iran’s medical education system. One of the strategies for medical education quality improvement is evaluation of the status quo and identification of the weaknesses. The purpose of the present study was to evaluate educational departments of Kashan Shahid Beheshti Teaching Hospital according to clinical education standards in line with the education reform plan and accreditation package. Methods: This cross-sectional study was performed on 210 stagers and interns of Shahid Beheshti Teaching Hospital of Kashan University of Medical Sciences in 2016. Subjects were selected by means of census method and data collection tool was a researcher-made questionnaire. The viewpoints of stagers and interns about the conformity of educational programs (round, grand round and morning report) with clinical education standards in departments of pediatrics, internal medicine, general surgery, cardiology, infectious diseases, neurology and specific surgery were assessed. Results: The highest rate of desirability of round from the viewpoints of stagers was related to infectious diseases (77.3%) and cardiology (66.7%) departments and from the viewpoints of interns was related to infectious diseases (60%) and neurology (40%) departments. The highest rate of desirability of grand round from the viewpoints of both stagers and interns was related to infectious diseases department (86.7% and 80% respectively). The highest rate of desirability of morning report from the viewpoints of both stagers and interns was related to the infectious diseases department (46.7% and 80% respectively). Conclusion: Given the moderately desirable status of educational programs in most of the departments, faculty members should get familiarized with new trends in medical education and clinical education standards through holding clinical education workshops and be encouraged to follow these standards. Moreover, departments should make efforts to eliminate weaknesses and achieve the desirable status

Protection and disinfection policies against SARS-CoV-2 (COVID-19)

In late December 2019, reports from China of the incidence of pneumonia with unknown etiology were sent to the World Health Organization (WHO). Shortly afterwards, the cause of this disease was identified as the novel beta-coronavirus, SARS-CoV-2, and its genetic sequence was published on January 12, 2020. Human-to-human transmission via respiratory droplets and contact with aerosol infected surfaces are the major ways of transmitting this virus. Here we attempted to collect information on virus stability in the air and on surfaces and ways of preventing of SARS-CoV-2 spreading

Intestinal parasitic infections in different groups of immunocompromised patients in Kashan and Qom cities, central Iran

<p><b>Introduction:</b> Intestinal parasitic infections (IPIs) are important causes of morbidity and mortality in patients with immunocompromising conditions.</p> <p><b>Objective:</b> The aim of this study was to determine the prevalence of IPIs in different groups of immunocompromised patients, including hemodialysis patients (HD), renal transplant recipients (RTR), cancer and HIV/AIDS patients in comparison with healthy individuals in two central cities of Iran (Kashan and Qom).</p> <p><b>Methods:</b> In this case–control study, the stool samples of 135 HD, 50 RTR, 60 cancer patients, 20 HIV/AIDS patients and 120 healthy subjects were tested using direct-smear, formol-ether concentration, Ziehl–Neelsen staining and Agar plate method.</p> <p><b>Results:</b> The overall infection rate was 11.7% (31/265) in patient groups and 0% (0/120) in the control group. The frequency of parasites was 25% in HIV/AIDS patients, 11.9% (16/135) in HD, 12.0% (6/50) in RTR and 6.7% (4/60) in cancer patients. <i>Blastocystis hominis</i> (4.2%) and <i>Giardia lamblia</i> (3.0%) were the most prevalent parasites in patient groups. The infection rate was significantly higher in male (17.6%) than female (5.4%) patients (<i>p</i> = .002), but no statistically significant association was observed according to the age and educational levels.</p> <p><b>Conclusions:</b> This study showed a high prevalence of IPIs in immunocompromised patients. The results of this study suggest that periodic stool examinations for screening of IPIs should be included as a part of routine medical care in these patients.</p