Simultaneous endobronchial and mediastinal mucormycosis in a patient with Diabetes Mellitus and SARS-CoV-2: A case report and literature review.

Background: Mucormycosis can be lethal in people with immunocompromising conditions, especially Diabetes Mellitus. Correction of the underlying disorders, instant initiation of antifungal therapy, and surgical resection are the main components of treatment. Herin, we present the successful medical management of Mucormycosis in a patient with Diabetic Ketoacidosis and positive SARS-CoV-2 test who presented with a less seen condition: the simultaneity of mediastinal mass on one side and an endobronchial mass on the other. Case presentation: An 18-year-old male with a history of insulin-dependent DM from 4 years ago presented to our hospital with sudden onset dyspnea, chest pain, sore throat, hoarseness, cough, and sputum. Also, we detected unilateral swelling in the neck and multiple lymph nodes in the neck. Lung auscultation revealed bilateral generalized wheezing. Primary laboratory tests detected high blood sugar, metabolic acidosis, positive urine ketone, high ESR, positive CRP, and leukocytosis; his polymerase chain reaction (PCR) for SARS-CoV-2 was positive. Chest X-ray showed left upper lobe consolidation. Computed tomography scan (CT-scan) of the chest revealed a large collapse consolidation in the left lung, mild left side pleural effusion, mediastinal lymphadenopathy, and distention in the esophagus. With suspicion of malignancy, we performed flexible bronchoscopy and endobronchial Ultrasound (EBUS) which revealed a creamy tumoral lesion in the right main bronchus. The biopsy was consistent with Mucormycosis. We successfully treated Mucormycosis with Amphotericin-B liposomal. Conclusion: Mucormycosis can mimic the clinical characteristics of malignancy, and emphasize the importance of considering appropriate differential diagnoses because timely diagnosis and treatment is potentially life-saving in Mucormycosis.

Right atrial thrombus and pulmonary thromboembolism related to ovarian hyperstimulation syndrome: A case report and literature review.

A young lady with a history of infertility presented to the hospital with dyspnea and chest pain a few days after ovulation induction. Her manifestations were consistent with ovarian hyperstimulation syndrome (OHSS). Further investigations revealed right atrial thrombus and pulmonary thromboembolism. We successfully managed the condition with conservative therapy.

Pneumoscrotum, a Rare Presentation of Barotrauma Following Noninvasive Positive Pressure Ventilation in Patients with Severe COVID-19 Pneumonia:.

BACKGROUND: Patients with Coronavirus disease 2019 (COVID-19) pneumonia are at risk of hypoxemic respiratory failure. Hence, many patients may require noninvasive positive pressure ventilation (NIPPV) during their hospital course. Using mechanical ventilation such as bilevel positive airway pressure or a ventilator to provide NIPPV may result in adverse events, including barotrauma. CASE REPORT: We reported two cases (40- and 43-years-old men) of severe COVID-19 pneumonia and hypoxemic respiratory failure who underwent NIPPV for respiratory support. These cases were complicated with barotrauma in their course of hospital admission that manifested with pneumoscrotum. CONCLUSION: In the cases of pneumoscrotum, it is crucial to understand its underlying etiology and origin since this clinical finding may be the outcome of life-threatening illnesses requiring urgent treatment.

Bronchial Anthracofibrosis and Tracheobronchomalacia.

BACKGROUND: Tracheobronchomalacia (TBM), presenting with the softening of the walls of trachea and bronchi, can cause respiration problems. Despite the importance of TBM, data on its prevalence and related factors are limited. In the current study, the prevalence and predictive factors of this illness were investigated. METHODS: This cross-sectional study was conducted on patients who were bronchoscopy candidates in the diagnostic department of pulmonary diseases in Afzalipour hospital in Kerman, Iran, from May 2017 to May 2018. First, all patients diagnosed with TBM were assessed based on their demographic variables, spirometry indices, anthracofibrosis and TBM severity. TBM was defined as a 50% or higher decrease in the diameter of the main tracheal and bronchial walls on expiration. These patients constituted the case group. Other patients for whom the bronchoscopy findings were not in concordance with TBM were selected through convenience sampling as control group to equal the number of patients in the case group. Data were analyzed using SPSS version 23. RESULTS: In this study, 132 (9.38%, 95% CI: 8-11) of the total 1406 cases who underwent bronchoscopy had tracheomalacia. Also, 22 patients (16.66%) had bronchomalacia, at the same time. Based on the multivariable logistic test results, age (P = 0.03, 95% CI: 1.00-1.04, OR = 1.02) and having anthracofibrosis (P<0.0001, 95% CI: 1.26-4.68, OR = 2.43) were identified as predictive factors for tracheomalacia. CONCLUSION: The findings of the present study suggest that the presence of anthracotic plaques can be considered as a possible predictive factor for TBM.

Biochemical and cytological analyses of pleural effusion in patients with lung anthracosis and antracofibrosis.

BACKGROUND: Anthracosis and anthracofibrosis are attributed to the deposition of carbon particles along with fibrosis, adhesion, narrowing, and collapse. There has been no study on the characteristics of the pleural fluid in anthracosis. The present study analyzed the biochemical characteristics of pleural effusion in patients with pulmonary anthracosis. PATIENTS AND METHODS: The study is a cross-sectional study which included patients who were referred to the Afzalipour Hospital in Kerman, eastern Iran. Between April 2018 and October 2019, patients who had undergone bronchoscopy and were diagnosed with anthracosis and pleural effusion were selected through the census method. The characteristics of the pleural fluid were analyzed for protein, albumin, LDH, PH, Triglyceride, cholesterol, glucose, and cytology. Concomitant blood samples were examined for LDH, albumin, total protein, and glucose. After it was specified whether the pleural effusion was transudative or exudative, patients with lymphocyte-dominant exudative pleural fluid became candidates for thoracoscopy. RESULT: 106 patients (6.21 %) of 1705 patients had anthracosis and anthracofibrosis; 37 of these patients (34.9 %) had coexisting pleural effusion. 31 patients gave written informed consent for thoracentesis. The mean age of the patients was 76.48 ± 8.81. In addition, 67.74 % of the patients were female. Pleural effusion was transudative in 29 (93.54 %). Except for one case, all patients had diffuse anthracofibrosis and 67.74 % of the patients had a history of baking bread. CONCLUSION: According to the findings of this study, most cases had transudative lymphocyte-dominant pleural fluid with mostly diffuse anthracofibrosis. In addition, this condition is more prevalent in women, with a prevalence of approximately twice that of men.

A Rare Report of Lung Metastasis of the Common Non-Melanotic Skin Cancer.

Basal cell carcinoma is a common non-melanotic skin cancer with a prevalence of 74.5%-82.6% in the Iranian population. BCC rarely metastasizes. However, metastasis can cause significant morbidity. The prevalence of metastatic basal cell carcinoma varies between 0.0028% and 0.55% of all cases. We describe a case of lung metastasis of basal cell carcinoma of the scalp.

In Vitro Antiparasitic and Apoptotic Effects of Antimony Sulfide Nanoparticles on Leishmania infantum.

Visceral leishmaniasis is one of the most important sever diseases in tropical and subtropical countries. In the present study the effects of antimony sulfide nanoparticles on Leishmania infantum in vitro were evaluated. Antimony sulfide NPs (Sb(2)S(5)) were synthesized by biological method from Serratia marcescens bacteria. Then the cytotoxicity effects of different concentrations (5, 10, 25, 50, and 100 µg/mL) of this nanoparticle were assessed on promastigote and amastigote stages of L. infantum. MTT method was used for verification results of promastigote assay. Finally, the percentages of apoptotic, necrotic, and viable cells were determined by flow cytometry. The results indicated the positive effectiveness of antimony sulfide NPs on proliferation of promastigote form. The IC(50) (50% inhibitory concentration) of antimony sulfide NPs on promastigotes was calculated 50 µg/mL. The cytotoxicity effect was dose-dependent means by increasing the concentration of antimony sulfide NPs, the cytotoxicity curve was raised and the viability curve of the parasite dropped simultaneously. Moreover, the IC(50) of antimony sulfide NPs on amastigote stage was calculated 25 µg/mL. On the other hand, however, antimony sulfide NPs have a low cytotoxicity effect on uninfected macrophages but it can induce apoptosis in promastigote stage at 3 of 4 concentrations.

IL-23 receptor gene rs7517847 and rs1004819 SNPs in ulcerative colitis.

BACKGROUND: Crohn's disease (CD) and ulcerative colitis (UC) are two major clinical presentations of inflammatory bowel disease (IBD). Many novel candidate genes have been found to be associated with increased risk for IBD. Recently IL-23 receptor gene is identified as an IBD associated gene in genome-wide studies. OBJECTIVE: To ascertain whether rs7517847 and rs1004819 SNPs in the IL-23 receptor gene are associated with UC in our population in Kerman, south east of Iran. METHODS: A total of 85 patients with UC and 100 healthy controls enrolled in our study. Endoscopic procedure was performed for all patients to determine their disease severity. IL-23 receptor genotyping at positions rs7517847 and rs1004819 was done by PCR-RFLP technique. RESULTS: The results of this study showed no association between the studied polymorphisms in the IL-23 receptor gene and UC in our population. However, we found a significant association between rs7517847 gene polymorphism in IL-23 receptor and two important clinical variables including blood in stool and bowel movements in UC patients. CONCLUSION: The rs7517847 gene polymorphism in IL-23R may be related to the presence of blood in stool and bowel movements in patients with UC. Further functional analysis with other known IL-23 receptor genotypes and/or other candidate genes is necessary to confirm any genetic association with UC in our population.