The relationship between COVID-19 and hyperglycemia: screening and monitoring hospitalized patients.

BACKGROUND: Elevated blood glucose concentration, also known as hyperglycemia, has been identified as a significant factor influencing the prognosis of COVID-19, alongside the impact of the SARS-CoV-2 infection itself. METHODS: This research is a cross-sectional investigation that examined the relationship between COVID-19 and hyperglycemia in patients admitted to Afzalipour Hospital in Kerman, Iran, from July to September 2021. A standardized data sheet was used to capture demographic data (age, gender) and laboratory information (blood sugar, arterial blood oxygen saturation, and C-reactive protein (CRP)) upon admission. RESULTS: The present research evaluated a total of 300 individuals diagnosed with COVID-19, with an average age of 50.19 ± 15.55 years. Among these patients, the majority were male, accounting for 51.67% of the total. Hyperglycemia was seen in 21.67% of patients, but less than 20% had new-onset diabetes. Individuals exhibiting hyperglycemia were typical of advanced age (P < 0.001). Furthermore, there was a slight but statistically significant association between advanced age and elevated blood glucose concentration (R = 0.254, P < 0.001). Gender had no significant impact on the occurrence of hyperglycemia (P = 0.199). There was no significant association between CRP levels and blood glucose concentration (P = 0.524) or the incidence of hyperglycemia (P = 0.473). Although there was no significant disparity in blood oxygen saturation between individuals with or without hyperglycemia (P = 0.06), higher blood glucose concentration was correlated with lower blood oxygen saturation (R = -0.151, P < 0.001). CONCLUSION: Considering the correlation between blood glucose concentration, advanced age, and disease severity, it is recommended to carefully screen and monitor all COVID-19 patients for hyperglycemia and new-onset diabetes. Effective management of these complications could enhance the control of patients' overall prognosis and subsequent complications.

Multiple intracranial tuberculomas in an elderly patient: A central nervous system tuberculosis case in the emergency department.

A 67-year-old male presented to the emergency department with a 7-day history of fever, malaise, myalgia, headache, and a seizure episode. Physical examination showed stable vital signs but a fever. Laboratory tests indicated leukocytosis, anemia, thrombocytosis, and elevated inflammatory markers. Imaging revealed multiple intracranial lesions, and cerebrospinal fluid analysis confirmed the presence of acid-fast bacilli. The patient responded well to anti-tuberculosis therapy, showing significant clinical improvement within 8 weeks.

Diversity of Rickettsia species in collected ticks from Southeast Iran.

Rickettsia occurs worldwide and rickettsiosis is recognized as an emerging infection in several parts of the world. Ticks are reservoir hosts for pathogenic Rickettsia species in humans and domestic animals. Most pathogenic Rickettsia species belong to the spotted Fever Group (SFG). This study aimed to identify and diagnose tick fauna and investigate the prevalence of Rickettsia spp. in ticks collected from domestic animals and dogs in the rural regions of Kerman Province, Southeast Iran. In this study, tick species (fauna) were identified and 2100 ticks (350 pooled samples) from two genera and species including Rhipicephalus linnaei (1128) and Hyalomma deteritum (972) were tested to detect Rickettsia genus using Real-time PCR. The presence of the Rickettsia genus was observed in 24.9% (95%CI 20.28-29.52) of the pooled samples. Sequencing and phylogenetic analyses revealed the presence of Rickettsia aeschlimannii (48.98%), Rickettsia conorii israelensis (28.57%), Rickettsia sibirica (20.41%), and Rickettsia helvetica (2.04%) in the positive samples. The results showed a significant association between county variables and the following variables: tick spp. (p < 0.001), Rickettsia genus infection in ticks (p < 0.001) and Rickettsia spp. (p < 0.001). In addition, there was a significant association between tick species and host animals (dogs and domestic animals) (p < 0.001), Rickettsia spp infection in ticks (p < 0.001), and Rickettsia spp. (p < 0.001). This study indicates a high prevalence of Rickettsia spp. (SFG) in ticks of domestic animals and dogs in rural areas of Kerman Province. The health system should be informed of the possibility of rickettsiosis and the circulating species of Rickettsia in these areas.

Evaluation of Laboratory Findings of Patients with Coronavirus Disease 2019 in Kerman, Iran.

Background & Objective: Since December 2019 in Wuhan, China there is a new form of pneumonia and after expansion in other countries, World Health Organization (WHO) called it Coronavirus Disease 2019 (COVID-19). Since the clinical laboratory findings have played an important role in the progression of the disease, this study aimed to evaluate the laboratory findings in COVID-19 patients (before vaccination). Methods: In this case-control study that was conducted from February to August 2020; the laboratory test status in 101 positive COVID-19 patients was evaluated and compared with 101 healthy individuals. Results: The results of our study showed that 21% of patients had low WBC, 24.75% low RBC, 37.62%, low Hb, 18.81% with low HCT, 29.7%, low Plt, 41.58% had High PT, 71.29% high CRP, 17.82% high urea, 11.88% high CR, 15.84% high LDH, 10.89% low sodium, 14.75% low potassium (K). The quantitative examination of blood factors showed that lymph%, mixed%, PLT, HCT, Hb, and RBC were higher in the control group than in the case group. While Neu%, WBC, PTT, CRP, UREA, LDH, K in the patient group were higher than in the control group. Conclusion: According to the results of the study, it can be concluded that in the clinical treatment of COVID-19 patients, much attention should be paid to the laboratory indicators to identify and intervene early in critically ill patients.

Mediterranean spotted fever as a non-endemic disease in the southeast of Iran: Diagnosis and treatment based on specific skin lesion.

Key Clinical Message: Rickettsia spp. should be investigated if Tache Noire, as a dark plaque covering a superficial ulcer surrounded by scale, edema, and erythema, are observed, even in non-endemic areas of Rickettsia spp. Abstract: A 31-year-old man with fever, dyspnea, abdominal pain, and jaundice has been admitted to the hospital in the southeast of Iran. Due to the presence of a pathognomonic skin lesion (Tache noire), the patient was diagnosed with Mediterranean spotted fever (MSF) and was treated with doxycycline, without waiting for PCR and IFA findings.

Disseminated cutaneous leishmaniasis in a kidney transplant recipient.

Key Clinical Message: In this case of disseminated cutaneous leishmaniasis in our immunosuppressive patient who was a refractor to treatment with intra-lesion Glucantime® and systemic L-AmB, considering the good clinical response to oral miltefosine, this drug might be the best treatment option. Abstract: Diagnosis and treatment of leishmaniasis are challenging in immunosuppressed patients. Here, we report a 46-year-old male renal transplant recipient with disseminated cutaneous leishmaniasis presenting with multiple lesions on the face and upper extremities 15 years after transplant with a challenging course of treatment with meglumine antimoniate, liposomal amphotericin B, and miltefosine.

Co-infection of coronavirus disease 19 and cytomegalovirus in a kidney transplant recipient.

It has been suggested that severe SARS-CoV-2 infection could be a risk factor for Herpesviridae reactivation due to the state of sepsis-associated immunosuppression. We presented the case of co-infection of CMV and COVID-19 infection in a 43-year-old woman with end-stage renal disease.

An update on spotted fever group serology in Kerman Province, Iran.

Rickettsia conorii is the causative agent of Mediterranean spotted fever (MSF) and reports of its geographical distribution are spreading every day. Recently, some cases of the MSF have been reported from Iran. However, little information is available about the MSF epidemiology in Iran. The aim of the current study was to investigate anti-R. conorii IgG seroprevalence among farmers living in the rural regions of Kerman province (in southeastern Iran). In this study, 281 blood samples were collected from farmers in Zarand and Jiroft counties and tested for detection of anti-R. conorii IgG antibodies using the ELISA method. Among the 281 samples, 14 farmers (4.98%, CI 95%; 2.45-7.55%) had anti-R. conorii IgG antibodies. Seroprevalence of MSF in Zarand and Jiroft counties were 4.58% and 5.33%, respectively. The serological evidence of this study indicates the seroprevalence of R. conorii in rural areas of the Kerman province of Iran. So, it is recommended that the Iranian health care system pay attention to the MSF.

Rickettsia conorii subsp. israelensis infection: a case report from southeast Iran.

BACKGROUND: Mediterranean spotted fever (MSF) is a zoonotic and vector-borne disease caused by Rickettsia conorii. We report a case (36 year-old-woman) of MSF caused by Rickettsia conorii from Iran. CASE PRESENTATION: In September 2019, the patient was admitted to the hospital in Kerman province with flu-like symptoms and maculopapular lesions. According to the laboratory results, thrombocytopenia, elevated liver enzymes, and cardiac enzymes were observed. Skin biopsy was examined for Crimean-Congo Hemorrhagic Fever (CCHF) and MSF using the Real-Time-PCR and ELISA method. Finally, the sample was positive for Rickettsia conorii subsp. israelensis and treated with doxycycline and completely recovered. CONCLUSIONS: This study showed that MSF could be present in Iran. Therefore, identifying endemic areas in Iran for this disease should be on the agenda.

Fatal Case of Mediterranean Spotted Fever Associated with Septic Shock, Iran.

A fatal case of Mediterranean spotted fever associated with septic shock was reported in a 61-year-old man living in a village in southeastern Iran. The patient had a history of tick bite a few days before symptom onset. Phylogenetic analysis confirmed infection by Rickettsia conorii subspecies israelensis.

Pathogenesis of COVID-19; Acute Auto-inflammatory Disease (Endotheliopathica & Leukocytoclastica COVIDicus).

BACKGROUND: The pathogenesis of the COVID19 pandemic, that has killed one million nine hundred people and infected more the 90 million until end of 2020, has been studied by many researchers. Here, we try to explain its biological behavior based on our recent autopsy information and review of literature. METHODS: In this study, patients with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) result were considered eligible for enrollment. Histopathological examinations were done on 13 people who were hospitalized in Afzalipour hospital, Kerman, Iran. Clinical and laboratory data were reviewed. Tissue examination was done by light microscopy, immunohistochemistry and electron microscopy. RESULTS: The most frequent co-morbidity in the patients was cardiovascular disease. The common initial symptoms of COVID-19 infection were dyspnea and cough. In all cases, the number of white blood cells was higher than the normal range. Common histopathological findings were variable degrees of vasculitis as degenerative to necrotic changes of endothelium and trafficking of inflammatory cells in the vessel wall with fibrinoid necrosis. Tissue damage included interstitial acute inflammatory cells reaction with degenerative to necrotic changes of the parenchymal cells. CD34 and Factor VIII immunohistochemistry staining showed endothelial cell degeneration to necrosis at the vessel wall and infiltration by inflammatory cells. Electron microscopic features confirmed the degenerative damages in the endothelial cells. CONCLUSION: Our histopathological studies suggest that the main focus of the viral damage is the endothelial cells (endotheliopathica) in involved organs. Also, our findings suggest that degeneration of leukocytes occurs at the site of inflammation and release of cytokines (leukocytoclastica) resulting in a cytokine storm.

Cases of Mediterranean spotted fever in southeast of Iran.

In this study the clinical manifestations, laboratory findings, and management of five patients diagnosed with Mediterranean spotted fever (MSF) from southeast of Iran are presented. All patients but one had recent tick-bite histories which were noticeable as black eschars (tache noire). Patients' samples were tested by real-time PCR and serology (IFA). The disease was confirmed by fourfold rising of IgG antibodies against Rickettsia conorii. This is the first report of MSF cases in Iran.

First reported case of unrepaired tetralogy of Fallot complicated with coronavirus disease-19 (COVID-19).

The incidence of novel coronavirus disease-19 (nCoV-19) and its associated complications is higher in high-risk groups. In this article, we explain the symptoms and course of the disease and the treatment for an adult patient with CHD who has been infected with novel nCoV-19.

HIV-Related Stigma Among Healthcare Providers in Different Healthcare Settings: A Cross-Sectional Study in Kerman, Iran.

BACKGROUND: Stigmatizing attitudes among healthcare providers are an important barrier to accessing services among people living with HIV (PLHIV). This cross-sectional study aimed to assess the status and correlates of HIV-related stigma among healthcare providers in Kerman, Iran. METHODS: Using a validated and pilot-tested stigma scale questionnaire, we measured HIV-related stigma among 400 healthcare providers recruited from three teaching hospitals (n=363), private sectors (n=28), and the only voluntary counseling and testing (VCT) center (n=9) in Kerman city. Data were gathered using self-administered questionnaires at participants' workplace during Fall 2016. To examine the correlates of stigmatizing attitudes, we constructed bivariable and multivariable linear regression models. RESULTS: The mean ± standard deviation (SD) of stigma score was 25.95 ± 7.20 out of the possible 50, with higher scores reflecting more stigmatizing attitudes. Paramedics, nurses' aides, and housekeeping staff had the highest, and VCT personnel had the lowest average stigma scores, respectively. Multivariable regression analyses showed that prior experience of working with PLHIV (ß=-2.48; P=.03), exposure to HIV-related educational courses (ß=-2.03; P=.02), and <10 years of work experience (ß=-2.70; P<.001) were associated with lower stigma scores. CONCLUSION: Our findings highlight the need for health managers to provide training opportunities for healthcare providers, including programs that focus on improving HIV-related knowledge for healthcare providers. Enforcing policies that aim to reduce HIV-related stigma and discrimination among healthcare providers in Iran are urgently needed.

Species-dependent Clinical Findings of Malaria Caused by Various Plasmodia in an Endemic Area of Kerman Province, Southeastern Iran.

BACKGROUND: Malaria is a big problem of public health in many tropical countries where socioeconomic development is deficient. Four species of plasmodium are capable of infecting human: P. falciparum, P. malaria, P.vivax, P. ovale. Southeastern corner of Iran, including Sistan and Baluchestan, Hormozgan and the tropical part of Kerman Province, are endemic region of malaria. This study aimed to find out clinical findings in malaria caused by various plasmodium species in moderate transmission area of southern Kerman Province. METHODS: This study was conducted in health centers of Kahnooj, Manujan, Ghale-Ganj, Roudbar and Fariab in south of Kerman Province, Southeastern Iran during 2005-2009. Three hundred and thirty patients with positive malaria parasite slides entered the study. Frequencies of several malaria clinical presentations were investigated in four plasmodium species. RESULTS: 54.2% of considered patients were male. Mean age of patients was 22.8±17.8 yr. Younger and older patient were 6 months and 80 yr, respectively. Ten patients were infected with P. falciparum, 314 with plasmodium vivax and 6 with mixed infection. The symptoms of fever, chills and sweating were present in 74.6% of subjects. Other complaints were joint pain, headache, fatigue, vomiting, and diarrhea. Splenomegaly was detected in 17.57% of the individuals. CONCLUSION: Malaria should be considered in differential diagnosis of all acutely febrile patients in endemic area. Classic symptoms of fever, chills and sweating may not present in all of patients.

Surveillance, control and management of infections in intensive care units in Southern Europe, Turkey and Iran--a prospective multicenter point prevalence study.

OBJECTIVE: We aimed to compare the features of intensive care units (ICUs), their antimicrobial resistance patterns, infection control policies, and distribution of infectious diseases from central Europe to Mid-West Asia. METHODS: A cross-sectional point prevalence study was performed in 88 ICUs from 12 countries. Characteristics of ICUs, patient and antibiotic therapy data were collected with a standard form by infectious diseases specialists. RESULTS: Out of 749, 305 patients at least with one infectious disease were assessed and 254 patients were reported to have coexistent medical problems. When primary infectious diseases diagnoses of the patients were evaluated, 69 had community-acquired, 61 had healthcare-associated, and 176 had hospital-acquired infections. Pneumonia was the most frequent ICU infection seen in half of the patients. Distribution of frequent pathogens was as follows: Enteric Gram-negatives (n = 62, 28.8%), Acinetobacter spp. (n = 47, 21.9%), Pseudomonas aeruginosa (n = 29, 13.5%). Multidrug resistance profiles of the infecting microorganisms seem to have a uniform pattern throughout Southern Europe and Turkey. On the other hand, active and device-associated infection surveillance was performed in Turkey more than Iran and Southeastern Europe (p < 0.05). However, designing antibiotic treatment according to culture results was highest in Southeastern Europe (p < 0.05). The most frequently used antibiotics were carbapenems (n = 92, 30.2%), followed by anti-gram positive agents (vancomycin, teicoplanin, linezolid, daptomycin, and tigecycline; n = 79, 25.9%), beta-lactam/beta lactamase inhibitors (n = 78, 25.6%), and extended-spectrum cephalosporins (n = 73, 23.9%). CONCLUSION: ICU features appears to have similar characteristics from the infectious diseases perspective, although variability seems to exist in this large geographical area.