Subacute thyroiditis after SARS-CoV-2 vaccination: A case report.

Key Clinical Message: Subacute thyroiditis which is typically characterized by cervical pain and fever is caused by viral infection and is seen after SARS-CoV-2 vaccination. Here we report a post-vaccination subacute thyroiditis after SARS-CoV-2 vaccination. Abstract: Subacute thyroiditis (SAT) is possibly caused by a viral infection and is typically characterized by cervical pain and fever. SAT associated with SARS-CoV-2 infection or SARS-CoV-2 vaccination has been reported, albeit in limited numbers. A 34-year-old woman was referred to our clinic with typical SAT symptoms. The diagnosis was confirmed through thyroid scintigraphy after receiving the SARS-CoV-2 vaccination, despite testing negative for COVID-19 via RT-PCR. There is a theoretical correlation between SARS-CoV-2 vaccination and SAT. Vaccination may have a direct or indirect impact on the thyroid, but further studies are required to confirm this relationship. A systematic review of the literature of similar cases was performed for comparison. Ultimately, the overall benefits of SARS-CoV-2 vaccination outweigh the potential adverse effects. Therefore, these types of reports should not divert attention from the actual reality.

Glycemic control and associated factors among type 2 diabetes mellitus patients: a cross-sectional study of Azar cohort population.

BACKGROUND: Despite the growing prevalence of diabetes and its complications, there is a dearth of data regarding factors associated with glycemic control. Therefore, in this cross-sectional study, we aimed to identify factors influencing glycemic control in patients with type 2 diabetes mellitus (T2DM) in the Iranian population. METHODS: This cross-sectional study was conducted among the Azar cohort population and the glycemic control status of patients with T2DM was investigated. Possible risk factors including age, sex, marital status, educational level, smoking status, sleep duration, family history of diabetes and hypertension, socioeconomic status, physical activity level, and co-existence of other chronic diseases and their relationship with glycemic control status were also assessed. Multivariate logistic regression analysis was used to identify determinants of glycemic control. RESULTS: Among 1,710 T2DM patients (60.2% female), the overall prevalence of poor glycemic control was 56.8%. In the unadjusted logistic regression analysis model, a low wealth score index significantly increased the risk of poor glycemic control (OR: 1.49;1.10-2.02). Variables significantly associated with poor glycemic control even after adjusting for confounding factors were first-degree family history of diabetes (OR: 1.34; 1.08-1.65), and sleep duration (OR: 1.29 ;1.02-1.62 for 6.6-8 h/d; OR:1.42;1.10-1.88 for > 8 h/d). Interestingly, we found that the co-existence of ≥ 3 chronic diseases with diabetes decreased the risk of poor glycemic control. CONCLUSIONS: In the current study, most of the patients with T2DM had uncontrolled glycemic control. Due to the individual and social costs of diabetes complications, it is necessary to suggest tailored and effective interventions for controlling blood glucose levels in people with diabetes.

Renal aspergillosis after COVID-19-associated pulmonary aspergillosis: A case report.

Key Clinical Message: Renal aspergillosis is a rare condition and this case the first case of Renal aspergillosis reported after COVID-19-associated pulmonary aspergillosis. Renal symptoms should arise clinical suspicion to renal involvement that happened as a result of hematogenous spreading of pulmonary aspergillosis. Abstract: Secondary fungal infections are among the most significant complications that can arise after COVID-19 and have the potential to lead to a high rate of morbidity and mortality. As COVID-19 primarily involves the airway, the majority of fungal infections reported have been related to the respiratory system. However, renal aspergillosis that we have reported is a rare condition that also can occur. A 67-year-old man was referred to our hospital and admitted as a COVID-19 patient. After the initial recovery, he experienced a recurrence of fever accompanied by a productive cough. The histopathological studies were conducted on the sputum and bronchoalveolar lavage samples, which revealed the presence of Aspergillus flavus. We treated the patient with voriconazole and the patient was discharged after a period of time. However, after approximately 6 months, he returned to the hospital with a fever and abdominal pain. We started a fever workup. Two new hypoechoic abscess-like masses were spotted in the right kidney in the ultrasonography (U/S) and the direct molecular studies of the biopsy sample obtained under U/S guidance identified Aspergillus flavus. Although renal aspergillosis is a rare condition, it should not be overlooked, especially in patients with severe COVID-19 and pulmonary aspergillosis, as these conditions can lead to renal aspergillosis, which may present with symptoms such as abdominal pain with fever. Therefore, it is necessary to perform radiological and histopathological studies when renal aspergillosis is suspected.

Serum neurofilament light chain in LRRK2 related Parkinson's disease: A five years follow-up.

BACKGROUND: Studies revealed that serum neurofilament light chain (NFL) levels not only increase considerably over time in Parkinson's disease (PD) but also have a significant association with disease progression. However, there is no evidence of the level of serum NFL in PD patients with leucine-rich repeat kinase 2 (LRRK2) mutation (LRRK2-PD) which is the most common mutation that causes familial and sporadic PD. AIM: Here we aimed to investigate the difference and longitudinal alteration of the serum level of NFL in LRRK2-PD and idiopathic PD (iPD) patients. METHODS: We entered 228 iPD and 103 LRRK2-PD patients and 176 healthy controls (HCs) from PPMI. We compared the level of serum NFL at baseline, six months, one year, two years, three years, and five years visits. Also, we used linear mixed models to assess longitudinal changes of serum NFL over six months, one year, two years, three years, and five years within groups. RESULTS: We found a significant difference in the level of serum NFL between three groups at baseline, two years, three years, and five years time points. Also, our analysis showed that LRRK2-PD patients had significantly lower serum NFL compared to iPD subjects at baseline. In the longitudinal analysis, there was no significant change in the HCs group over five years. The level of serum NFL was significantly increased after two, three, and five years from baseline in LRRK2-PD patients. Also, we found similar results for iPD subjects after three and five years from baseline. CONCLUSION: We can conclude that the overall neurodegeneration might be similar in LRRK2-PD and healthy subjects and lower than the idiopathic form of PD at the early stages, which may disappear in the later stages. Moreover, our findings suggest that the serum NFL might be a more accurate biomarker to distinguish iPD from healthy subjects rather than all PD patients or LRRK2-PD from healthy subjects at the early stages.

The prevalence of substance use among drivers with traffic injuries in Mazandaran Province, Northern Iran.

Background: Motor vehicle accidents (MVAs) are one of the main causes of mortality in developing countries. Although the association between alcohol and the risk of MVA has been known for a long time, only a few studies have been conducted on driving following substance consumption in a short period of time. This is while narcotic and stimulant use seems to be a threat to traffic safety and a serious health concern for substance users. In this study, we investigated the prevalence of substance use (narcotics and stimulants) in drivers with traffic injuries admitted to the orthopedic ward of Imam Khomeini Hospital between October 2020 and June 2021. Methods: The current research is a cross-sectional, descriptive-analytical study. The statistical population consisted of 77 patients admitted to the orthopedic ward of a training hospital (Imam Khomeini) in Mazandaran Province, northern Iran. The Shapiro-Wilk test was used to determine the quantitative variables. The sampling method is random and consecutive. The method of data collection was through questionnaire tools. The software used was SPSS 26 with an independent t-test, Mann-Whitney U test, Chi-square or Fisher's exact test. Results: In this study, the frequency of substance use was 18.18%. The prevalence of opioid usage was 35.7% and for stimulants it was 64.28%. There was no case of concomitant use of opioids and stimulants. In the opioid group, 60% of patients used opium, 20% methadone, and 20% tramadol. In the stimulant and alcohol groups, 12.12% utilized methamphetamine and 88.88% drank alcohol. The average age of consumers was 39 years, which was significantly higher in the opioid group (P = 0.040). The education level of substance users was remarkably lower (P < 0.05) and, occupationally, there was no statistically significant difference between groups of substance users (P = 0.290). Considerably, the unemployed population consumed more substances (P = 0.001). Multiple fractures (P < 0.05) and surgical treatment (P = 0.012) were more common in the user group. Conclusion: Users of stimulants and alcohol were younger than opioid users, according to our results. There is an association between drug use and the incidence of traffic accidents, as well as lower educational levels, masculinity, fracture type, and patient complication type.

Exploring the Association Between Latent Toxoplasma gondii Infection and COVID-19 in Hospitalized Patients: First Registry-Based Study.

PURPOSE: This study aimed to determine the possible association between Toxoplasma gondii infection and COVID-19 outcomes among 133 patients with an RT-PCR-positive test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), hospitalized at Imam Khomeini Hospital, Sari, Mazandaran Province, northern Iran, during August to November 2020. METHODS: A questionnaire was used to collect baseline data from the patients who were registered to the Iranian National Registry Center for Toxoplasmosis (INRCT). Also, blood samples were taken from each patient for detecting anti-T. gondii antibodies and T. gondii DNA using enzyme-linked immunosorbent assay (ELISA) and conventional-PCR methods, respectively. Variables related to the COVID-19 severity and outcomes were indicated based on multiple multinomial logistic regression models. RESULTS: Of 133 patients enrolled in the INRCT with COVID-19 through RT-PCR, 50 (37.59%), 52 (39.1%), and 31 (23%) suffered from mild, moderate, and severe COVID-19, respectively. 57.1% of the patients who died had severe COVID-19, while among those with other outcomes, only 18.60% had severe COVID-19 (P < 0.05). Anti-T. gondii IgG was detected in 109/133 (81.95%) patients, which was not statistically significant (P > 0.05). Among those with negative and positive anti-T. gondii IgG, 2 (8.30%) and 29 (26.60%) had severe COVID-19, respectively (P > 0.05). T. gondii DNA and anti-T. gondii IgM were not found in any of the patients. Moreover, all deaths occurred in those with moderate or severe COVID-19 and a positive anti-T. gondii IgG. CONCLUSION: To our knowledge, this is the first registry-based study concerning T. gondii infection among patients with COVID-19. Our data show the high rate of latent T. gondii infection among COVID-19 with different severity. However, there is no significant relationship between latent T. gondii infection and COVID-19 severity and outcomes. Thus, conducting multicenter studies in different geographic regions of the world could offer a better understanding of this relationship.

Rhabdomyolysis due to warfarin and atorvastatin combination therapy in a patient with ischemic heart disease: (A drug interaction).

INTRODUCTION: Although atorvastatin has serious adverse effects, including hepatotoxicity and myopathy, it can cause drug interactions and side effects such as rhabdomyolysis and acute kidney injury, especially when combined with warfarin, which uses the same enzyme pathway for metabolism. CASE PRESENTATION: We describe a 66-year-old man with a history of ischemic heart disease who developed renal complications and rhabdomyolysis after concomitant use of atorvastatin and warfarin. DISCUSSION: Statins reduce serum LDL cholesterol levels significantly. It is a safe and cost-effective medicine used in the treatment of DLP as well as the primary and secondary prevention of CAD, atherosclerosis, myocardial infarction, and stroke. Despite their benefits, statins can cause side effects in various organs of the body, including the gastrointestinal tract, CNS, liver, and kidneys. CONCLUSION: Statins are widely prescribed to patients with cardiovascular problems. Therefore, clinicians should pay attention to the patient's medical history, current prescribed doses, and drug interactions when adding new drugs or adjusting existing drugs.

Suicide attempt using zinc phosphide rodenticide: A case report and literature review.

The patients with a history of intentional or unintentional consumption of rodenticide compounds, especially ZnP, it is necessary to assess ABG and abdominal radiography.