Colonic basidiobolomycosis in a child: report of a culture-proven case

SummaryBasidiobolomycosis is a rare fungal disease caused by Basidiobolus ranarum, which is endemic in tropical and subtropical regions of Africa, Asia, and Latin America. Gastrointestinal basidiobolomycosis poses diagnostic difficulties due to the non-specific clinical presentation and absence of predisposing factors. Eight pediatric cases of the disease have been reported recently from Iran, but none of these, or most of the other cases reported in the literature, has been proven by culture, which is the gold standard method for diagnosis. We present a case of culture-proven colonic basidiobolomycosis that occurred in a 3-year-old boy. The outcome was successful following surgical excision and antifungal therapy with posaconazole

Train-the-trainers in hand hygiene : a standardized approach to guide education in infection prevention and control

Background Harmonization in hand hygiene training for infection prevention and control (IPC) professionals is lacking. We describe a standardized approach to training, using a “Train-the-Trainers” (TTT) concept for IPC professionals and assess its impact on hand hygiene knowledge in six countries.Methods We developed a three-day simulation-based TTT course based on the World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy. To evaluate its impact, we have performed a pre-and post-course knowledge questionnaire. The Wilcoxon signed-rank test was used to compare the results before and after training.Results Between June 2016 and January 2018 we conducted seven TTT courses in six countries: Iran, Malaysia, Mexico, South Africa, Spain and Thailand. A total of 305 IPC professionals completed the programme. Participants included nurses (n = 196; 64.2%), physicians (n = 53; 17.3%) and other health professionals (n = 56; 18.3%). In total, participants from more than 20 countries were trained. A significant (p < 0.05) improvement in knowledge between the pre- and post-TTT training phases was observed in all countries. Puebla (Mexico) had the highest improvement (22.3%; p < 0.001), followed by Malaysia (21.2%; p < 0.001), Jalisco (Mexico; 20.2%; p < 0.001), Thailand (18.8%; p < 0.001), South Africa (18.3%; p < 0.001), Iran (17.5%; p < 0.001) and Spain (9.7%; p = 0.047). Spain had the highest overall test scores, while Thailand had the lowest pre- and post-scores. Positive aspects reported included: unique learning environment, sharing experiences, hands-on practices on a secure environment and networking among IPC professionals. Sustainability was assessed through follow-up evaluations conducted in three original TTT course sites in Mexico (Jalisco and Puebla) and in Spain: improvement was sustained in the last follow-up phase when assessed 5 months, 1 year and 2 years after the first TTT course, respectively.Conclusions The TTT in hand hygiene model proved to be effective in enhancing participant’s knowledge, sharing experiences and networking. IPC professionals can use this reference training method worldwide to further disseminate knowledge to other health care workers.peer-reviewe

Correction to : Train-the-trainers in hand hygiene : a standardized approach to guide education in infection prevention and control

Correction to: Antimicrob Resist Infect Control https://doi.org/10.1186/s13756-019-0666-4 The original article [1] contained a misspelling in author, Fernando Bellissimo-Rodrigues’s name which has since been corrected.peer-reviewe

Clinical Features and Long Term Prognosis of Childhood Brucellosis in Northeast Iran

Objective: Brucellosis is a prevalent disorder in children of developing countries. The aim of this study is to describe the epidemiology and long term prognosis of Brucellosis in Khorasan, Iran. Methods: This is a descriptive cross sectional study (from November 2003 up to February 2006), the subjects of which are composed of 82 patients (from Imam Reza hospital, Mashhad, and Health Center of Kashmar). In this study the diagnosis of Brucellosis is based on serology accompanied with clinical signs and symptoms. Our strategy for duration of treatment was to treat all patients for at least 6 weeks. We followed the patients by phone and if necessary by visiting. Findings: During 38 months we had 82 children with Brucellosis. The mean age was 8.02 y, and 40% of them were girls (M/F=1.21). Summer with 45.9% of the cases was the peak season. History of consuming raw dairy products, close contact with farm animals, living in village and Brucellosis in family was found in 91.6%, 76%, 70.24% and 41.1% of the cases respectively. The presenting symptom in 79.7% of the cases was joint pain, 72.9% had history of fever during the course of the disease. Arthritis, splenomegaly and lymphadenopathy were found in 60.97%, 16.9%, 7.5%, of patients respectively. The therapeutic regimen of 48.7% of our patients was Co-trimoxazole and rifampin. We followed 74% of the patients for at least 3 years which showed the relapse rate of 6.5 %. There was a case of reinfection, a patient with residual sequel and one death related to Brucellosis in our case series. Conclusion: Brucellosis is still a common disease in our children and at least a risk factor for it can be found in the history of almost all cases of pediatric Brucellosis. With at least six weeks treatment with two antibiotics and with close follow up, we can decrease the relapse rate in pediatric Brucellosis to zero, even without repeating the serology during or after treatment

How to encounter the child in coma

Non-traumatic coma is a medical emergency and should be evaluated as soon as possible. Pediatric coma is more serious because of patient’s capacity of pathological stressor tolerance is limited especially in neonates. Several etiologies could be listed for loss of consciousness (LOC) and coma in childhood. According to the epidemiological studies, causes of coma are different all around the world. Glasgow Coma Scale has been used for coma scaling. In this review, we focused on some highlight causes of coma in pediatric medicine

Emojis in public health and how they might be used for hand hygiene and infection prevention and control

Emojis are frequently used picture characters known as possible surrogates for non-verbal aspects of behavior. Considering the ability of emojis to enhance and facilitate communication, there has been a growing interest in studying their effects in scientific and health-related topics over the past few years. Infection prevention and control (IPC) is a field of medicine that is directly associated with specific behaviors. These include hand hygiene, which is the cornerstone of the prevention of healthcare-associated infections, and essential in stemming the spread of antimicrobial resistance. This paper aims to provide an overview of how emojis have been used in the medical and public health literature and proposes their possible use in IPC and hand hygiene to put forth a vision for the future research

Moyamoya Disease Mimicking Encephalitis

Moyamoya disease is a rare vaso-occlusive illness with an unknown etiology characterized by stenosis of the internal carotid arteries with spontaneous development of a collateral vascular network. A 15-month-old girl was referred to the emergency ward of Imam Reza Hospital due to decreased level of consciousness, focal seizures and fever during the previous 24 hours with an impression of encephalitis. Physical examination revealed left side hemiparesis; however brain CT-Scan did not show any significant lesions. Initial therapy with vancomycin, ceftriaxone and acyclovir was administered. CSF analysis did not show any abnormality and the blood as well as CSF cultures results were negative. Brain MRI showed hyperintensity at right frontal and parietal regions, suggesting vascular lesion. Magnetic resonance angiography (MRA) showed bilaterally multiple torsions in vessels at the basal ganglia consistent with moyamoya vessels. In all children exhibiting encephalitis, vascular events such as moyamoya disease should be considered. Brain MRI is a critical tool for this purpose. Common causes of encephalitis such as herpes simplex should also be ruled out

Medical Information Sources Used by Specialists and Residents in Mashhad, Iran

Background: Physicians continually need to update their knowledge to ensure appropriate decision making about patient care. Objectives: We aimed to identify and compare information sources used by specialists and residents, their reasons for choosing these sources, and the level of their confidence in these sources. Materials and Methods: We conducted a cross-sectional study among specialists and residents using a validated questionnaire in the five academic hospitals affiliated with Mashhad University of Medical Sciences (in northeast Iran). We compared the specialists with residents in terns of gender, age, years since graduation, use of information sources, confidence in use of information sources, and reasons for selecting the information sources. Within each group, we also investigated the effect of work experience and gender on frequently used information sources and users' confidence in them. Results: The questionnaire was sent to 315 physicians, including 155 specialists and 160 residents. One hundred twenty-six specialists (response rate: 81 %) and 126 residents (response rate: 79%) completed it. The most frequently mentioned sources by all specialists included "English textbooks" (84.9%), "web/internet" (74.6%), "English medical journals" (62.3 %), and "discussions with colleagues" (57%). Among residents, "web/internet" ( 65.9%), "discussion with colleagues" (61.3%), and "Persian textbooks" (50.4%) were the most frequently used sources of information. In both groups, high confidence was demonstrated in "English textbooks," "English medical journals," and "international instructions/guidelines." Both groups counted reliability, easy accessibility, and being up to date as their primary reasons for the selection of their information sources. There was also a significantly negative correlation between using the internet as an information source and age in specialists (Spearman's rho=-0.238, p=0.01), but not in residents. Conclusions: Reliability, easy accessibility, and being up to date should be considered in establishing information sources for physician

COVID-19 in Children with Congenital Heart Diseases: A Multicenter Case Series from Iran

Background. Promptly discovering and counteracting COVID-19 is critical as it could have catastrophic effects. As an asymptomatic group, children are highly susceptible to be misdiagnosed, especially those suffering from underlying diseases. Furthermore, discriminating the direct effects of the virus from those of the underlying diseases can pose a dilemma to physicians. This case series aims to determine the relationship between COVID-19 and various types of congenial heart disease among children. Patients and Methods. Seven patients from three different medical centers were enrolled. Their detailed demographic information, past medical history, symptoms, type of congenital heart diseases, imaging tests, laboratory tests, medications, and outcomes were analyzed. Results. The patients included 4 infants, 1 child, and 2 adolescents, with a median age of 9 months and a majority of boys. All of them had either obstructive lesions (right or left ventricular outflow tracts) or significant pulmonary hypertension. The more common clinical symptoms were cough, dyspnea, and fever. Two patients did not survive the illness. Conclusion. Prompt treatment of patients with a combination of COVID-19 and severe obstructive cardiac pathology or pulmonary hypertension is essential due to a risk for serious and/or fatal consequences

Infective Endocarditis Presented as a Right Atrium Mass in a Patient with Ulcerative Colitis

Involvement of the heart is infrequently seen in irritable bowel syndrome (IBD). We present a case of severe acute infective endocarditis diagnosed as ulcerative colitis in further workup