Leprosy of the larynx: A case report

Leprosy is an ancient deforming disease caused by Mycobacterium leprae, which is still poorly understood and often feared by the general public and even by some in the health care professions Fortunately, the outlook for patients has dramatically improved over the last three decades with the introduction of multi-drug treatment and management strategies that have somewhat diminished the stigma of this diagnosis. We report a rare case of leprosy of larynx. A 45 year old man presented with complaints cough, dyspnea and hoarseness since many years ago. Because of demonstration of acid fast bacilli in smear of his sputum, the diagnosis of tuberculosis was made and anti tuberculosis treatment was initiated. But he developed fever and his symptoms exacerbated. In examination there was a tender erythematous nodule on right supraclavicular region, loss of eyebrows and lashes and disseminated hyper and hypo pigmented cutaneous lesions on abdomen, thorax, back with normal chest x ray. Laryngoscopy to rule out laryngeal tuberculosis was done and granulomatous lesion was seen. Laryngeal and skin biopsy was performed which numerous acid fast bacilli, macrophages and foamy cells suggestive of lepromatous leprosy were demonstrated in both specimens. Treatment was started on multi bacillary regime of WHO multidrug therapy. In conclusion, this report highlights the importance of systemic involvement in lepromatous leprosy especially when the initial presentation is laryngitis or respiratory symptoms. Laryngeal leprosy may mistaken with tuberculosis laryngitis due to respiratory problems and existence of acid fast bacilli in respiratory secretions. © 2009 Tehran University of Medical Sciences. All rights reserved

Antibiotic Resistance of Vibrio cholerae Isolates from Kashan, Iran

Aims: Cholera is an acute diarrheal disease that can lead to severe dehydration and death. Antibiotic resistance is a big challenge in infective disease like Cholera. The present study aimed to understand the characteristics and trends of antibiotic resistance of V. cholerae isolations in and around Kashan, Iran. Instrument & Methods: In this descriptive cross-sectional study, samples were gathered using census method from 1998 to 2013 in Kashan, Iran. 1132 fecal samples of patients with acute diarrhea and 237 samples of suspected water samples were taken. The serotypes and biotypes were determined by an enzymatic method. Antibiotic susceptibility test was performed by using Disk Diffusion Method. Data were analyzed using SPSS 23 software. Fisher-exact and Chi-square tests were used to compare the statistical parameters. Findings: 96 fecal samples (8.5) and 18 water samples (7.6) were positive for Vibrio cholerae. Non-agglutinating (Nag) isolates (75.4) were more common than serotype Inaba (13.2) and Ogawa (11.4). Nag serotypes were mostly resistant to cefixime (44) and ampicillin (33). In contaminated water samples also the most frequent cases were Nag serotype (50). Nag serotype showed 22.2 of resistance to ampicillin and nitrofurantoin. Conclusion: Vibrio cholerae isolates in Kashan, Iran, are highly resistant to antibiotics, especially Nag serotypes

Effective Factors on Needle Stick Injuries in Health Care Workers

Aims: Needle stick accidents are a serious health risk for blood-borne infections among health care workers. This study was conducted to evaluate the frequency of needle stick injuries in health care workers and its related factors. Instrument & Methods: This cross-sectional study was carried on HCWs of Shahid Beheshti Hospital of Kashan City, Iran (270 individuals), from September 2013 to March 2014. Due to the low number of samples, all those who had the experience of needle stick injuries and confirmed to participate were entered to the study. A researcher-made questionnaire with 20 questions was used. Data were analyzed by SPSS 16 software using descriptive statistics. Findings: The most injuries of needle sticks (75.2) were superficial and the most common device for NSIs was the needle of syringe (51.8). Blood sampling was the most common activity during NSIs (28.4). The most common contamination was blood and its products (69.5). 61 participants (43.3) used gloves during NSIs. 118 participants (83.7) were vaccinated completely against hepatitis B, and 19 participants (13.5) had incomplete HBV vaccination. 4 participants (2.8) had no history of vaccination against hepatitis B. Conclusion: Needle stick injuries among health care workers of Kashan Hospital are relatively high

Factors affecting the outcome of community-acquired pneumonia among the patients hospitalized in Beheshti hospital (Kashan-Iran)

Background: Community-acquired pneumonia (CAP) is a common infectious disease with high morbidity and mortality. The goal of this study was to evaluate the factors affecting the outcome of pneumonia among the Beheshti hospital patients. Materials and Methods: This cohort study was done on pneumonia patients (n=140) in Kashan Beheshti hospital during 2014-2015. A questionnaire consisting the demographic, clinical and paraclinical findings and outcomes was filled-out. Results: Eighty three (59.3) out of 140 patients were male and 57(40.7) women. The majority of cases were ≥50 years old (mean age 60.02±1.70) .There was a history of diabetes in 54(38.6) .The most common signs and symptoms were coughing and the lung rales. The ninty-one and 9 of the cases were improved and complicated condition, respectively. The complication were: pleural effusion (77), empiyema (15) and abscess (8).There was positive CRP (100); increased ESR (82) and leukocytosis (80). While, there was no statistical association between the sex, age and clinical symptoms with the disease complication and outcome, there was a significant correlation between the first BS, HbA1C, CRP, duration of hospitalization, radiographic pattern and diabetes with disease outcome. Conclusion: Considering the association between the diabetes in one side and some factors (outcome of pneumonia, duration of hospitalization, history of pneumonia, times of admission, BS at admission, HbA1c, bilateral involvement, leukocytosis, increased ESR, CRP and CURB 65, the diabetes should be considered as an important factor affecting the pneumonia outcome. The managed control of diabetes can improve the pneumonia outcome

Rapid detection of pathogenic bacteria in whole blood samples using 23S rRNA PCR assays

Purpose: Bloodstream infections are a general cause of death among hospitalized patients. Rapid diagnosis and timely treatment can reduce mortality. The aim of this investigation was to evaluate the 23S rRNA PCR assays as a rapid detection method for diagnose of sepsis in patients with suspected bacteremia. Methods: A cross-sectional study was conducted at Shahid Beheshti University Hospital in Kashan from November 2017 to December 2018. The blood samples of 265 patients with suspected bacteremia were studied by blood culture and 23S rRNA PCR techniques. The results were analyzed using SPSS version 16 and Chi-square test. Results: Eighty (30.2) blood samples of 265 suspected patients, were identified as positive by PCR assays, whereas 27 (10.2) were identified as positive by the blood culture technique. The statistical analysis showed a significant association between the results of PCR assays and blood culture and factors such as prior antibiotic use and underlying diseases (P <0.05). Also a significant correlation was observed between laboratory and clinical criteria and the results of both PCR assays and blood culture (P < 0.05). Conclusion: The 23S rRNA PCR method is a rapid and sensitive technique specially for diagnosing sepsis among patients in whom bacteremia is difficult to diagnose with culture method including neonates and patients who have taken antibiotics before microbial culture. © 2019 Firoozeh et al. All rights reserved

Seroepidemiology of Toxoplasma gondii infection in immunodeficiency patients in Kashan and Qom during 2014-2015

Background: Toxoplasma gondii is an opportunistic parasitic protozoon, which is a causative agent of serious complications such as encephalitis in immunodeficiency patients. Considering insufficient data on toxoplasmosis in these patients, the present study was conducted to determine the seroepidemiology of T. gondii among immunodeficiency patients. Materials and Methods: This cross-sectional study was conducted on cancer, ADIS, hemodialysis and renal transplant patients (case group) and healthy persons (control group) in Kashan and Qom cities. Totally, 317 serum samples were collected from the case group and 120 samples from the control group. The ELISA method was used to determine the anti-T. gondii IgG and IgM antibodies. Results: Totally, 60.3 of the samples from the case and 33.3 from the control groups were positive for anti-T. gondii IgG (P&lt;0.001). In the case group, only 2 persons (0.6) were positive for anti-T. gondii IgM. The anti-T. gondii IgG detected in immunodeficiency patients was 55.2 in Kashan and 68 in Qom, which were higher than in the control group (P&lt;0.001, P&lt;0.006, respectively). The highest prevalence of T. gondii were seen in 40-59 years old (49.8) and illiterate (60) patients. There was a meaningful correlation between toxoplasmosis and blurry vision and dermal rash (P=0.001 and P=0.003, respectively). Conclusion: The prevalence of T. gondii was higher in different immunodeficiency patients compared to healthy persons. Screening examinations were recommended for the diagnosis and treatment of patients to prevent serious side-effects and health education

Magnesium Supplementation and the Effects on Wound Healing and Metabolic Status in Patients with Diabetic Foot Ulcer: a Randomized, Double-Blind, Placebo-Controlled Trial

Hypomagnesemia is associated with the development of neuropathy and abnormal platelet activity, both of which are risk factors for diabetic foot ulcer (DFU). This study was carried out to evaluate the effects of magnesium administration on wound healing and metabolic status in subjects with DFU. This randomized, double-blind, placebo-controlled trial was performed among 70 subjects with grade 3 DFU. Subjects were randomly divided into two groups (35 subjects each group) to receive either 250 mg magnesium oxide supplements or placebo daily for 12 weeks. Pre- and post-intervention wound depth and appearance were scored in accordance with the “Wagner-Meggitt’s” wound assessment tool. Fasting blood samples were taken at baseline and after the 12-week intervention to assess related markers. After the 12-week treatment, compared with the placebo, magnesium supplementation resulted in a significant increase in serum magnesium (+0.3 ± 0.3 vs. −0.1 ± 0.2 mg/dL, P < 0.001) and significant reductions in ulcer length (−1.8 ± 2.0 vs. −0.9 ± 1.1 cm, P = 0.01), width (−1.6 ± 2.0 vs. −0.8 ± 0.9 cm, P = 0.02), and depth (−0.8 ± 0.8 vs. −0.3 ± 0.5 cm, P = 0.003). In addition, significant reductions in fasting plasma glucose (−45.4 ± 82.6 vs. −10.6 ± 53.7 mg/dL, P = 0.04), serum insulin values (−2.4 ± 5.6 vs. +1.5 ± 9.6 μIU/mL, P = 0.04), and HbA1c (−0.7 ± 1.5 vs. −0.1 ± 0.4%, P = 0.03) and a significant rise in the quantitative insulin sensitivity check index (+0.01 ± 0.01 vs. −0.004 ± 0.02, P = 0.01) were seen following supplementation of magnesium compared with the placebo. Additionally, compared with the placebo, taking magnesium resulted in significant decrease in serum high-sensitivity C-reactive protein (hs-CRP) (−19.6 ± 32.5 vs. −4.8 ± 11.2 mg/L, P = 0.01) and significant increase in plasma total antioxidant capacity (TAC) concentrations (+6.4 ± 65.2 vs. −129.9 ± 208.3 mmol/L, P < 0.001). Overall, magnesium supplementation for 12 weeks among subjects with DFU had beneficial effects on parameters of ulcer size, glucose metabolism, serum hs-CRP, and plasma TAC levels

Magnesium Supplementation and the Effects on Wound Healing and Metabolic Status in Patients with Diabetic Foot Ulcer: a Randomized, Double-Blind, Placebo-Controlled Trial

Hypomagnesemia is associated with the development of neuropathy and abnormal platelet activity, both of which are risk factors for diabetic foot ulcer (DFU). This study was carried out to evaluate the effects of magnesium administration on wound healing and metabolic status in subjects with DFU. This randomized, double-blind, placebo-controlled trial was performed among 70 subjects with grade 3 DFU. Subjects were randomly divided into two groups (35 subjects each group) to receive either 250 mg magnesium oxide supplements or placebo daily for 12 weeks. Pre- and post-intervention wound depth and appearance were scored in accordance with the �Wagner-Meggitt�s� wound assessment tool. Fasting blood samples were taken at baseline and after the 12-week intervention to assess related markers. After the 12-week treatment, compared with the placebo, magnesium supplementation resulted in a significant increase in serum magnesium (+0.3 ± 0.3 vs. �0.1 ± 0.2 mg/dL, P < 0.001) and significant reductions in ulcer length (�1.8 ± 2.0 vs. �0.9 ± 1.1 cm, P = 0.01), width (�1.6 ± 2.0 vs. �0.8 ± 0.9 cm, P = 0.02), and depth (�0.8 ± 0.8 vs. �0.3 ± 0.5 cm, P = 0.003). In addition, significant reductions in fasting plasma glucose (�45.4 ± 82.6 vs. �10.6 ± 53.7 mg/dL, P = 0.04), serum insulin values (�2.4 ± 5.6 vs. +1.5 ± 9.6 μIU/mL, P = 0.04), and HbA1c (�0.7 ± 1.5 vs. �0.1 ± 0.4, P = 0.03) and a significant rise in the quantitative insulin sensitivity check index (+0.01 ± 0.01 vs. �0.004 ± 0.02, P = 0.01) were seen following supplementation of magnesium compared with the placebo. Additionally, compared with the placebo, taking magnesium resulted in significant decrease in serum high-sensitivity C-reactive protein (hs-CRP) (�19.6 ± 32.5 vs. �4.8 ± 11.2 mg/L, P = 0.01) and significant increase in plasma total antioxidant capacity (TAC) concentrations (+6.4 ± 65.2 vs. �129.9 ± 208.3 mmol/L, P < 0.001). Overall, magnesium supplementation for 12 weeks among subjects with DFU had beneficial effects on parameters of ulcer size, glucose metabolism, serum hs-CRP, and plasma TAC levels. Clinical trial registration number: http://www.irct.ir: IRCT201612225623N96. © 2017, Springer Science+Business Media New York

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

Down-regulation of the tumor suppressor miR-34a contributes to head and neck cancer by up-regulating the MET oncogene and modulating tumor immune evasion

BACKGROUND: MicroRNAs (miRs) have been shown to play an important role in tumorigenesis, including in head and neck squamous cell carcinoma (HNSCC). The miR-34 family is thought to play a role in tumor suppression, but the exact mechanism of their action in HNSCC is not well understood. Moreover, the impact of chromosomal changes and mutation status on miR-34a expression remains unknown. METHODS: Differential expression of miR-34a, MET, and genomic alterations were assessed in the Cancer Genome Atlas (TCGA) datasets as well as in primary HNSCC and adjacent normal tissue. The biological functions of miR-34a in HNSCC were investigated in samples derived from primary human tumors and HNSCC cell lines. The expression of MET was evaluated using immunohistochemistry, and the molecular interaction of miR-34a and MET were demonstrated by RNA pulldown, RNA immunoprecipitation, luciferase reporter assay, and rescue experiments. Lastly, locked nucleic acid (LNA) miRs in mouse xenograft models were used to evaluate the clinical relevance of miR-34a in HNSCC tumor growth and modulation of the tumor microenvironment in vivo. RESULTS: Chromosome arm 1p loss and P53 mutations are both associated with lower levels of miR-34a. In HNSCC, miR-34a acts as a tumor suppressor and physically interacts with and functionally targets the proto-oncogene MET. Our studies found that miR-34a suppresses HNSCC carcinogenesis, at least in part, by downregulating MET, consequently inhibiting HNSCC proliferation. Consistent with these findings, administration of LNA-miR-34a in an in vivo model of HNSCC leads to diminished HNSCC cell proliferation and tumor burden in vitro and in vivo, represses expression of genes involved in epithelial-mesenchymal transition, and negates the oncogenic effect of MET in mouse tumors. Consistently, LNA-miR-34a induced a decreased number of immunosuppressive PDL1-expressing tumor-associated macrophages in the tumor microenvironment. In HNSCC patient samples, higher levels of miR-34a are significantly associated with a higher frequency of Th1 cells and CD8 naive T cells. CONCLUSIONS: Our results demonstrate that miR-34a directly targets MET and maintains anti-tumor immune activity. We propose miR-34a as a potential new therapeutic approach for HNSCC