A Review of Esophagitis Due to Candida Species in Human Immunodeficiency Virus (HIV) Infected Patients

The present study aimed to provide an overview of epidemiology, pathogenicity, clinical diagnosis, and treatment of Candida esophagitis in human immunodeficiency virus (HIV)-infected patients. The review process involved studying all the existing literature published on this Candida infection. Esophageal candidiasis (EC) is the most common manifestation of mucosal candidiasis and patients with HIV are predominantly at the risk of this opportunistic infection. The prevalence of EC indicated diverse ranges among HIV patients in different geographic areas due to antiretroviral therapy (ART). The main factors for EC were gastric ulcers, CD4+cell count 400 cells/mL in the ART era. However, a low CD4+ cell count (<200 cells/mL) was significantly associated with EC in the pre-ART era. The interactions between the Candida virulence factor and host immune defense lead to the host responses against this fungal pathogen. During the Candida albicans invasion, secretion of candidalysin which is encoded by the hyphal gene ECE1 has a potential role in epithelial cell damage and secretion of stimulated cytokine. Early trials of the empirical antifungal therapy are recommended before an endoscopic examination. Esophageal biopsy should be considered in patients with a failure of empiric antifungal treatment as it may allow the possibility of drug-resistant Candida and other opportunistic pathogens. The first-line induction treatment of Candida esophagitis is based on oral fluconazole. The shift from C. albicans to non-albicans Candida (NAC) may be correlated with the development of fluconazole resistance and relapse or therapeutic failure in this infection. An increase in the intrinsic and acquired resistance has raised the significance of the optimal antifungal therapy for the critically ill patient. Candida esophagitis requires a systematic suspicion for early diagnosis and appropriate management of HIV infected patients in order to prevent delayed treatment related to undesirable morbidity or even mortality scores

Prevalence and disease association of human parvovirus B19 in Iran : a systematic review

Aim: The prevalence of human parvovirus B19 (B19V) and its association with other diseases in Iran are yet to be systematically assessed. This study aimed to evaluate the prevalence and disease association of B19V across Iran from 2000 to 2019. Methods: The literature search, based on different keywords in different databases, was performed. A total of 29 eligible studies were included and the essential information was collected from each article. Results: The results of this study show a relatively high prevalence of the B19V-associated diseases in all age groups of the Iranian population. Conclusion: The transmission of B19V and its complications should be prevented by developing preventative strategies.Peer reviewe

2nd National Congress on Clinical Case Reports, December 26 and 27, 2018

The second annual meeting of Clinical Case Report (CCR) has been held in Karaj, Iran from the 26th to the 27th of December, 2018 (Figure 1). The congress was organized by the Clinical Research Development Center of Shahid Rajaei Educational and Therapeutic Center, Alborz University of Medical Sciences together (Figure 2), with a Scientific Committee including some of the faculty members of the university (Table 1). The conference program was organized into the following sessions: · Cardiovascular · Nursing · Pediatrics · Obstetrics and Gynecology · Internal Medicine · Surgery · Urology · Neurology and Neurosurgery · Orthopedics · Psychiatry · Laboratory Sciences · Infectious diseases · Traditional Medicine This meeting brought together clinician and researchers from several prestigious universities and research centers throughout Iran including Rasht, Torbat Heidarieh, Qazvin, Neyshahpour, Ardebil, Isfahan, Khorramabad, Tabriz, Hamedan, Marand, Bushehr, Mashhad, Ahvaz, Sanandaj, Bojnourd, Sabzevar, Kashan, Gorgan, Ilam, Dezful, Yazd, Tehran, Urmia and Semnan, as well as leading researchers from countries such as Turkey. Participants were invited to submit scientific contributions, as oral presentations or posters. After evaluation of the 858 abstracts received, the Scientific Committee selected 40 of them for oral presentations, and accepted 231 as posters

Outcome of TB in HIV patients treated with standard regimen

Background: HIV infection reduces the immune system and is the most significant factor in the spread of TB in recent years and one of the causes of death in HIV -seropositive patients. TB is the most commonly diagnosed opportunistic infection and the most frequent direct cause of death among HIV infected patients. The HIV infection can accelerate progression of TB infection to active TB disease. Among patients with active TB, those with HIV co-infection have the greatest risk for relapse. Regardless of increasing rate of TB and HIV in Iran, we decided to s urvey outcome of TB in HIV positive patients who treated with standard regimens in the years 2003-2012. Methods: This retrospective cohort study was conducted on HIV-positive patients with TB referred to Behavioral Diseases Consultation Center and Infectious Diseases Ward of Imam Khomeini Hospital from 2003 to 2012. Outcome was defined as failure, relapse and mortality. Moreover, the relationship between outcomes and number of CD4, co-trimoxazole and antiretroviral intake, type of TB and AIDS defining illness was studied. Results: This study had 135 patients, 8 (5.9%) were females and 127 (94.1%) were males. The mean age of the patients was 40.14+10.02 and the most way to catch HIV in this study was intravenous drug user. There were 3 (2.22%) cases of failure, 15 ( 11.1%) relapse , and 21 ( 15.8%) deaths. Antiretroviral therapy, AIDS defining illness, type of TB and co-trimoxazole intake did not soley affect relapse. CD4 level was the most effective variables in relapse [ Hazard ratio: 0.392 (0.11-1.4); Relative Risk: 0.809 (0.593-1.103) (P=0.068) ]. However, regard to CI95%, the impact of CD4 on relapse is not significant and antiretroviral intake was the most important and effective variable in increasing their survival. Hazard ratio: 0.137 (0.141-0.45); Relative Risk: 0.686 (0.513-0.918) (P=0.001) Conclusion: Overall, receiving antiretroviral was the most important factor influencing the outcome of patients

Severe Disseminated Phaeohyphomycosis in a Patient with Inherited CARD9 Deficiency

Contains fulltext : 203292.pdf (publisher's version ) (Open Access

Serum vitamin D level was not associated with severity of ventilator associated pneumonia

Background and Objective. Vitamin D deficiency is considered one of the most common nutritional deficiencies associated with weakened immune system and increased likelihood of sepsis. The current study was conducted to investigate the association between serum vitamin D level and the severity and prognosis of ventilator associated pneumonia (VAP) in inpatients in intensive care unit (ICU)

Effect of Ammonium Chloride in addition to standard of care in outpatients and hospitalized COVID-19 patients: A randomized clinical trial

Objective: The COVID-19 pandemic has called an urgent need for drug repurposing to improve the outcome of the disease. Quaternary ammonium compounds have been demonstrated to have antiviral effects and may be of use against SARS-CoV-2 infections. Design: In this double-blind, single-center study, we enrolled patients with positive PCR test and/or CT findings for COVID-19. The participants of each group were randomly assigned to Diphenhydramine Compound (Diphenhydramine + Ammonium Chloride) plus standard of care or to Diphenhydramine alone and standard of care groups. The primary outcome was all-cause mortality within 30 days of randomization. Secondary outcomes include viral burden, clinical status, assessed by a 5-point ordinal scale, and length of stay in hospitalized patients. Results: A total of 120 patients were included in the trial, 60 of which were assigned to the Ammonium Chloride group. The primary endpoint was not statistically different between the two groups (HR: 3.02 (95% CI, 0.57–16.06; p = 0.195)). Recovery time and viral burden were significantly lower in the Ammonium Chloride group, corresponding to an odds ratios of 1.8 (95% CI, 1.15–2.83; p = 0.01) and 7.90 (95% CI, 1.62–14.17; p = 0.014), respectively. Conclusion: The findings of this study advocate the careful addition of Ammonium Chloride to standard of care for COVID-19 patients