Jellyfish Stings Rarely Induced Infectious Cellulitis: First Aid Remedies as Double-Edged Sword

A 27-year-old woman was presented with a burning like lesion. The skin lesion was developed after a jellyfish stings (Rhizostomae) while she was swimming in Pattaya Sea in Thailand, five days prior to her presentation. Instantly after jellyfish stings, she was taken into the ship for rescue operations. The ship personnel applied lemon juice and baking soda to the injured area believing that this remedy is efficient in this situation. The next day, she referred to a local hospital at Pattaya because she was suffering from a horrible pain in her arm and then she was discharged on oral Dicloxacillin and topical Hydrocortisone. The edema was extended the next days which intensified her pain. At this time, she was transferred to Loghman Hakim Hospital, Tehran, Iran. At admission, erythematous edematous patch with centrally grouped vesicles on the left arm was observed (Figure 1). The patient had a high-grade fever (38.1 °C) and was agitated due to her intolerable pain. Other vital signs were normal. In the sonography imaging, soft tissue edema was seen without any collection. According to the clinical and imaging findings, the diagnosis of soft tissue cellulitis due to jellyfish stings was made. The patient admitted to infections ward and intravenous antibiotics including Cefazolin at dose of 2000 mg every eight hours and Vancomycin at dose of 1000 mg every 12 hours initiated. After five days of hospitalization, the patient was recovered from left arm edema. Also, her pain decreased gradually and no obvious erythema was seen. The patient was finally discharged with a satisfactory clinical respons

Assessment of Thyroid Dysfunction as a Predisposing Factor for Asymptomatic Bacteriuria in Women of Reproductive and Postmenopausal age

Background: Infectious diseases are associated with thyroid autoimmune disorders, mainly. Meanwhile, thyroid gland function as a risk factor for infectious diseases is a challenging debate topic that needs more evaluation. Considering the high burden of hypo and hyperthyroidism in many regions of the world and the consequences of these disorders on different aspects of human health, evaluating and screening high-risk populations and treating patients is of great importance. In the present research, we investigated any association between thyroid dysfunction and asymptomatic bacteriuria in women of reproductive and postmenopausal age. Materials and Methods: The study was performed for six years (between 2015-2021) in Tehran, Iran. Our study enrolled 188 women of reproductive and postmenopausal age with and without asymptomatic bacteriuria. All participants' thyroid stimulating hormone (TSH) and free T4 levels were evaluated. The association between thyroid dysfunction and asymptomatic bacteriuria was assessed. Results: The mean level of TSH in all culture-positive samples was 2.39, while it was 3.11 in culture-negative samples (P value < 0.05). The mean TSH level was 2.4 and 2.3 in Escherichia coli and Non- E. coli positive urine cultures, respectively (P value= 0.67). Asymptomatic bacteriuria was significantly more common in patients with lower TSH levels. The mean level of free T4 in all participants was 8.21, with maximum and minimum levels of 12.3 and 4, respectively. Also, the mean level of free T4 in all culture-positive samples was 9.53, while 7.13 in culture-negative samples (P value=0.09). The mean free T4 level was 9.36 and 10.03 in E. coli and Non-E. coli positive urine culture respectively (P value= 0.35). Conclusion: Our study revealed a significant correlation between the population's TSH level and asymptomatic bacteriuria. Also, it showed no significant association between TSH level and any specific uropathogenic

Jellyfish Stings Rarely Induced Infectious Cellulitis: First Aid Remedies as Double-Edged Sword

A 27-year-old woman was presented with a burning like lesion. The skin lesion was developed after a jellyfish stings (Rhizostomae) while she was swimming in Pattaya Sea in Thailand, five days prior to her presentation. Instantly after jellyfish stings, she was taken into the ship for rescue operations. The ship personnel applied lemon juice and baking soda to the injured area believing that this remedy is efficient in this situation. The next day, she referred to a local hospital at Pattaya because she was suffering from a horrible pain in her arm and then she was discharged on oral Dicloxacillin and topical Hydrocortisone. The edema was extended the next days which intensified her pain. At this time, she was transferred to Loghman Hakim Hospital, Tehran, Iran. At admission, erythematous edematous patch with centrally grouped vesicles on the left arm was observed (Figure 1). The patient had a high-grade fever (38.1 °C) and was agitated due to her intolerable pain. Other vital signs were normal. In the sonography imaging, soft tissue edema was seen without any collection. According to the clinical and imaging findings, the diagnosis of soft tissue cellulitis due to jellyfish stings was made. The patient admitted to infections ward and intravenous antibiotics including Cefazolin at dose of 2000 mg every eight hours and Vancomycin at dose of 1000 mg every 12 hours initiated. After five days of hospitalization, the patient was recovered from left arm edema. Also, her pain decreased gradually and no obvious erythema was seen. The patient was finally discharged with a satisfactory clinical respons

Daclatasvir/Sofosbuvir versus Ledipasvir/Sofosbuvir in Patients with Hepatitis C Virus Infection Genotypes 1 and 3

Background: The new direct-acting antiviral agents (DAAs) with high efficacy, low resistance, and low rate of adverse events (AEs) have shown promising outcomes for hepatitis C virus (HCV) treatment. This study assessed the efficacy and safety of Daclatasvir/Sofosbuvir (DCV/SOF) compared to Ledipasvir/Sofosbuvir (LDV/SOF) in patients with HCV infection in the real-world setting in Iran. Materials and Methods: A total of 42 patients with HCV infection were treated with either LDV/SOF (genotype 1) or DCV/SOF (genotypes 1, 3 or unknown) with or without ribavirin (RBV). Assessment of risk factors, laboratory tests, sustained virologic response at post-treatment week 12 (SVR12), and AEs were performed. Results: The highest risk factor for HCV transmission was major surgery (50.0%), followed by tattooing (40.5%), phlebotomy (40.5%), and dental surgery (40.5%). No statistically significant relationships between genotypes and risk factors were observed. In both treatment groups (LDV/SOF and DCV/SOF), all of the patients (100%) with or without cirrhosis and treatment-experience achieved SVR12. One patient with a history of failed LDV/SOF therapy achieved SVR12 following retreatment with DCV/SOF. Both treatment regimens were well-tolerated. No serious AEs or discontinuation due to AEs was observed. The most common AE across both treatment groups were fatigue (42.9%), followed by anxiety (28.6%). Numerically, more adverse events were found with the LDV/SOF regimen than with the DCV/SOF regimen. Conclusion: Our study showed an excellent safety and efficacy of DCV/SOF and LDV/SOF in Iranian patients infected with HCV. The incidence of AEs among patients treated with LDV/SOF was higher than those receiving SOF/DCV

Investigation of the Frequency of Foodborne Botulism in Patients Referred to Loghman Hospital in Tehran City, Iran, From 2008 to 2019

Background: Foodborne botulism is a fatal paralytic illness caused mainly by the neurotoxin produced by an anaerobic bacterium called Clostridium botulinum. In this study, the frequency of foodborne botulism in patients referred to a hospital in Iran has been reviewed for ten years.Methods: In this routine database study, medical records of patients with foodborne botulism referred to Loghman Hospital in Tehran City, Iran, from March 20, 2008, to March 20, 2019, were reviewed. Information on variables of age, sex, place of residence, food consumed, clinical symptoms of patients (such as dysphagia, nausea, vomiting, ataxia, etc.), toxin type, and length of hospitalization were collected with a researcher-made questionnaire. Finally, the collected data were analyzed in SPSS-24 with descriptive and analytical statistical tests.Results: In this study, 61 suspected botulism patients were clinically diagnosed in Loghman Hospital, of whom 55 patients were clinically suspected of foodborne botulism, 5 patients had iatrogenic botulism, and 1 patient had infant botulism. Of these 55 patients with the clinical diagnosis of foodborne botulism, 19 patients were confirmed by laboratory examinations, and 2 patients died. Sixteen patients confirmed by laboratory had neurotoxin botulinum type A. The mean age of the patients was 36.9 years with a standard deviation of 18.6 years. About 54.5% of the patients were male and 45.5% female. Weaknesses (58.2%), ptosis (droopy eyelid) (56.4%), and diplopia (double vision) (52.7%) were the common clinical symptoms of the patients under study. Canned foods and dairy products were the main foods consumed by the patients. The duration of admission time ranged between 1 and 41 days, with an average of 7.7 days. About 23.64% of patients were admitted to the intensive care unit.Conclusion: The prevalence of foodborne botulism is rare compared with other food poisonings but is still a major public health problem due to the consumption of traditional food products and unboiled canned foods in Iran

Assessment of Thyroid Dysfunction as a Predisposing Factor for Asymptomatic Bacteriuria in Women of Reproductive and Postmenopausal age

Background: Infectious diseases are associated with thyroid autoimmune disorders, mainly. Meanwhile, thyroid gland function as a risk factor for infectious diseases is a challenging debate topic that needs more evaluation. Considering the high burden of hypo and hyperthyroidism in many regions of the world and the consequences of these disorders on different aspects of human health, evaluating and screening high-risk populations and treating patients is of great importance. In the present research, we investigated any association between thyroid dysfunction and asymptomatic bacteriuria in women of reproductive and postmenopausal age. Materials and Methods: The study was performed for six years (between 2015-2021) in Tehran, Iran. Our study enrolled 188 women of reproductive and postmenopausal age with and without asymptomatic bacteriuria. All participants' thyroid stimulating hormone (TSH) and free T4 levels were evaluated. The association between thyroid dysfunction and asymptomatic bacteriuria was assessed. Results: The mean level of TSH in all culture-positive samples was 2.39, while it was 3.11 in culture-negative samples (P value < 0.05). The mean TSH level was 2.4 and 2.3 in Escherichia coli and Non- E. coli positive urine cultures, respectively (P value= 0.67). Asymptomatic bacteriuria was significantly more common in patients with lower TSH levels. The mean level of free T4 in all participants was 8.21, with maximum and minimum levels of 12.3 and 4, respectively. Also, the mean level of free T4 in all culture-positive samples was 9.53, while 7.13 in culture-negative samples (P value=0.09). The mean free T4 level was 9.36 and 10.03 in E. coli and Non-E. coli positive urine culture respectively (P value= 0.35). Conclusion: Our study revealed a significant correlation between the population's TSH level and asymptomatic bacteriuria. Also, it showed no significant association between TSH level and any specific uropathogenic

Prevalence of Helicobacter pylori infection and its associated factors in patients with COVID-19

Background: The severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) attaches to the angiotensin-converting enzyme-2 (ACE-2) receptors for penetrating cells. Because these receptors are extensively distributed in the intestine, coronavirus disease 2019 (COVID-19) may cause gastrointestinal (GI) symptoms. Helicobacter pylori (H. pylori) is known to increase the expression of ACE-2 receptors in the GI tract. This study aimed to investigate the prevalence of H. pylori infection and its associated factors in patients with COVID-19.Materials and Methods: This cross-sectional study was conducted from February to December 2021. A total of 215 patients who had been diagnosed with COVID-19 infections using a real-time PCR test or a CT scan were included in the study. The enzyme-linked immunosorbent assay (ELISA) test on serum samples was used to evaluate the presence of H. pylori.Results: All 215 positive patients for COVID-19 with a mean age of 59.72±17.23 were evaluated. Among them, 153 patients (71.2%) were H. pylori-positive. Moreover, H. pylori+/ COVID-19+ group showed higher mean age than H. pylori-/ COVID-19+ patients. However, there was no significant difference between the two groups of patients regarding their medical background, drug history, BMI, and disease severity. The prognosis of the patients was severely worse in the H. pylori+/ COVID-19+ than in H. pylori-/ COVID-19+ patients.Conclusion: Our study adds to the previous findings and provides evidence regarding the high prevalence of H. pylori in COVID-19 patients. These investigations could help us elucidate the relationship between H. pylori and respiratory system findings and better understand COVID-19

Evaluation of Outcome in Patients With Moderate and Severe COVID-19 Via H-Score

Background: Due to uncontrolled lymphocyte reaction, the overproduction of cytokines in COVID-19 patients can cause sepsis-like symptoms, suggesting sepsis, cytokine release syndrome (CRS), and secondary hemophagocytic lymphohistiocytosis (sHLH). Since different therapeutic approaches are used for each diagnosis, differentiation is essential. This study aims to use H-score as a possible prognostic tool in COVID-19 patients.Methods: A sample of 64 moderate and severe COVID-19 patients was enrolled in this study. Clinical and laboratory findings were assessed. H-score was initially calculated and reevaluated among severe cases 72 hours later and among moderate cases showing severe features of COVID-19.Results: Mortality of 31.3% was reported. Laboratory findings, including triglycerides (TG), ferritin, and aspartate aminotransferase (AST) showed significantly higher initial and follow-up laboratory assessment levels in severe cases than in moderate cases. Moreover, fibrinogen was significantly higher among severe cases than moderate cases at the initial assessment, but no significant difference was reported in the second fibrinogen assessment. Conclusion: In this study, H-score was useful as a predictive tool for the initial evaluation of severe cases of COVID-19. H-score is much lower in these patients than in non-COVID-19 HLH patients may be due to the different underlying immunologic pathophysiology of COVID-19; thus, each H-score criterion must be evaluated for sensitivity and specificity in COVID-19 patients. The H-score cut-offs, H-score may be useful for diagnosing immune overreaction and determining the need for more exclusive immunomodulatory treatments

A preliminary case series comparison of chest computerized tomography scan and Polymerase Chain Reaction (PCR) for COVID-19 contact tracing in developing countries with limited resources

Background: Imaging and PCR each have a role in detecting and implementing precautionary measures inisolating individuals with a history of close contact, which helps limit the COVID-19 pandemic. Due todeveloping countries' difficulties, PCR is limited in Iran. This study seeks to determine the feasibility of earlylow-dose chest computed tomography (CT) scans substitution with PCR.Materials and Methods: Asymptomatic participants with a history of close contact with a confirmed case ofCOVID-19 were enrolled and followed for one week, receiving 2 PCR tests within one week. Initially, a chestCT scan was performed. The second CT scan was performed within one week on two participants. Participantswith an initially negative CT scan and participants with a first CT scan compatible with COVID-19 who becamesymptomatic.Results: All Participants had an RT-PCR and at least one CT scan. Positive RT-PCR results were reported in6 and 9 participants initially and within one week, respectively. Chest CT scans favoring COVID-19 infectionwere initially reported in 4 and 6 participants within one week, respectively. Seventeen participants showedneither symptoms nor positive RT-PCR or chested CT scans favoring COVID-19. Thirteen participants eitherhad positive RT-PCR, a COVID-19 chest CT scan or became symptomatic.Conclusion: Rapid detection of COVID-19 and subsequent quarantining is crucial in the global fight againstthis pandemic. Our results showed lower sensitivity for chest CT scans compared to COVID-19 PCR,suggesting that chest CT scans are unsuitable for COVID-19 PCR tests

Frequency of Influenza-A-H1N1 in Patients with Community-Acquired Pneumonia Admitted to Loghman Hakim Hospital

Background: Here we assessed the incidence of Influenza-A-H1N1-related pneumonia in community-acquired pneumonia (CAP) at Loghman Hakim Hospital, Tehran, Iran.Materials and Methods: In this prospective study from November 22, 2016, to June 21, 2017, patients with CAP and suspected to seasonal influenza were included. Rapid Antigen test and quantitative real-time PCR assay were performed on samples. P-value &lt; 0.05 was considered significant. In addition, radiologic patterns of them were evaluated.Results: a total of 29 admitted CAP patients were suspected of seasonal influenza. Two cases out of them were positive for influenza by real-time PCR, similar to result of influenza rapid test. The most common finding in their chest X ray was consolidation in one lobe. None of them vaccinated against influenza. Only nine patients received empiric Oseltamivir treatment. The amount of irrational antibiotic administration was significant.Conclusion: Despite low statistical numbers, admitted influenza CAP patients did not have unusual symptoms and radiologic patterns. Other results in this study showed need for antibiotic stewardship program and better training about necessity of vaccination