Evaluation of Olfactory Function by Iranian Smell Diagnostic Test in Patients with Parkinson's disease in North of Iran.

INTRODUCTION: Parkinson's disease is a neurodegenerative and multisystem disorder affecting systems more than the motor system. The olfactory disorder is an early non-motor symptom of Parkinson's disease. MATERIALS AND METHODS: The present study was conducted on 110 patients aged 50-95 years with a diagnosis of Parkinson's disease referred to the Neurology Clinic of Babol University of Medical Sciences between 2018-2019. The control group consisted of 50-95-year-old non-neurological patients who were matched for age and gender with patients with Parkinson's disease. Data were collected by examination, demographic and clinical information questionnaire (duration of disease, the severity of disease, symptom index), as well as Iranian smell diagnostic test. A p-value less than 0.05 was considered statistically significant. RESULTS: The mean age scores of Parkinson's disease and control groups were obtained at 69±9 and 66±9 years, respectively. The mean duration of the disease was 5 years. Patients with Parkinson's disease scored lower on the Iranian smell test, and olfactory function was significantly reduced in the case group (P<0.001). Based on the results, olfactory function in patients with Parkinson's disease was not significantly correlated with gender, marital status, education, place of residence, and occupation(P<0.05). Only olfactory dysfunction was increased with age (P=0.01). In addition, olfactory dysfunction showed no significant relationship with severity of disease, duration of disease, and clinical index sign. Rapid Iranian smell test with a cut-off of 3.5% had a sensitivity of 87.3% and a specificity of 66.4%. CONCLUSION: According to the obtained results, olfactory dysfunction is an important non-motor and a primary symptom in patients with Parkinson's disease and is not related to the duration and severity of motor symptoms and symptom index.

First fluconazole-resistant Candida auris isolated from fungal otitis in Iran.

BACKGROUND AND PURPOSE: Candida auris, as a new characterized pathogenic yeast, has attracted remarkable attention in the recent decade due to its rapid global emergence and multidrug resistance traits. This unique species is able to cause nosocomial outbreaks and tolerate adverse conditions; however, it has been mostly misidentified by conventional methods. CASE REPORT: This report aimed to describe the first fluconazole-resistant case of C. auris otitis in an immunocompetent patient in Iran. The isolate showed minimum inhibitory concentration of ≥ 32 µg/ml for fluconazole; however, the patient was treated with topical clotrimazole and miconazole with no recurrence. CONCLUSION: This was the second strain of C. auris isolated from otitis in Iran which was fluconazole-resistant, unlike the first Iranian isolate.

Molecular Identification and Antifungal Susceptibility of Yeasts and Molds Isolated from Patients with Otomycosis.

Fungal otitis externa, an infection of the external auditory canal caused by molds and yeasts, accounts for approximately 10-20% of ear canal infections accompanying high recurrence. The purpose of the current study was to assess the pattern of etiological agents of otomycosis and resistance profile as well as the rate of tympanic membrane perforation. A total of 1040 patients with symptoms of fungal otitis externa, in a period of two years, were investigated. The mycological tests revealed the presence of different fungi in 237 ears (22.8%). Fungal otitis was more related to filamentous fungi of the species Aspergillus flavus (54.43%), A. tubingensis (10.97%), and A. niger (8.86%), followed by yeasts, Candida orthopsilosis (7.59%), C. albicans (6.75%), and C. parapsilosis (5.06%). Tympanic membrane perforation rate was found to be 6.75% and was more common with otomycosis caused by A. flavus, A. tubingensis and C. albicans. In antifungal susceptibility tests, all tested drugs showed generally good activity against most isolates of molds and yeasts, while tolnaftate, clotrimazole, nystatin, and terbinafine had lowest effects. We found that among Aspergillus isolates, one A. niger isolate was resistant to voriconazole, and one A. flavus isolate was resistant to amphotericin B. Furthermore, among Candida species, three isolates of C. orthopsilosis showed high MIC values to fluconazole, two C. albicans isolates were considered fluconazole resistant and one isolate of C. parapsilosis was resistant to caspofungin and 3 isolates were resistant to fluconazole. Regarding the existence of the cases with perforated tympanic membrane and emerging species causing fungal otitis in the current report, the importance of the early physical examination, precise molecular identification, and the antifungal susceptibility evaluation is highlighted.

Hearing status in patients with rheumatoid arthritis.

BACKGROUND: Previous studies showed that one of the complications of rheumatoid arthritis disease was auditory disorder. The goal of the present study was to compare the auditory status in patients with rheumatoid arthritis and healthy individuals. METHODS: In the present case-control study, 30 normal persons and 60 persons with rheumatoid arthritis with mean age of 46.72 and standard deviation of 6.76 of both genders were appraised using pure tone audiometry, tympanometry and speech audiometry. The mean disease duration in patients with rheumatoid arthritis was 12.51±6.09 years. RESULTS: The frequency of hearing loss in rheumatoid arthritis group was significantly more than the control group (p=0.001). All patients had sensorineural hearing loss. Only in 5% of rheumatoid arthritis group, abnormal tympanometry (as type) was reported. Speech discrimination score analysis showed significant difference between the patients with rheumatoid arthritis and controls. In terms of hearing threshold level, the mean hearing threshold level (in 2000, 4000 and 8000 Hz frequencies) of the patients with rheumatoid arthritis was significantly higher than control group in both ears (p<0.05). A positive significant correlation was found among mean hearing threshold level in 4000 and 8000 Hz frequencies and rheumatoid arthritis duration in both ears. CONCLUSION: The frequency of hearing loss and the average hearing threshold in RA patients were higher than healthy individuals. The most common type hearing loss is sensorineural.

Outer Ear Infections in Iran: A Review.

BACKGROUND: Otitis externa is the fungal and bacterial infection of the outer ear. AIM: We aimed to investigate the published papers about the outer ear infections in Iran and suggest standardised investigations and treatments. METHODS: We used different electronic databases like PubMed, Scopus, Web of Science, Iranmedex, Google Scholar, and Magiran with specific keywords. RESULTS: We obtained forty published full-text articles for review of data. Our results indicated the women were more infected than men. The ages of patients were < 1-81 years. As clinically symptoms, itching and Feel the ear fairy were the most common presenting complaints in most cases. Most infections were the pure bacterial and fungal origin, respectively. However, some of the studies were mixed fungal-bacterial infections - Pseudomonas spp. And Aspergillus niger were the most common bacteria and fungi isolates respectively in Iranian patents. CONCLUSION: Fungal and bacterial specific cultures may be recommended, and anti-fungal drugs may be added, to treatment regimens in patients with otitis externa to reduce the clinical symptoms.

Candida auris otomycosis in Iran and review of recent literature.

Candida auris is a multidrug-resistant yeast emerging in immunocompromised and in otherwise healthy individuals. Due to difficulties in microbiological identification of C. auris because of the lack of available laboratory technology in developing countries, the number of patients affected is most likely underestimated. We report the first case of C. auris otitis which now adds Iran as the fifth country around the Persian Gulf, in addition to Kuwait, Oman, United Arab Emirates and Saudi Arabia. Candida auris is an unknown pathogen in routine laboratories in Iran because most Candida isolates are probably misdiagnosed. Otomycosis seems to be a different clinical presentation of C. auris mainly involving isolates from the East-Asian clade. We compared the mycological and clinical details of the Iranian patient with other cases of otitis reported since the last review of C. auris otomycosis in 2017.

Role of Clotrimazole in Prevention of Recurrent Otomycosis.

Otomycosis is one of the relatively common diseases in the world which is caused by different fungi especially saprophytes. Concerning the relapse of this disease in a number of individuals, the present study was performed to evaluate the inhibitory effect of clotrimazole drop in the relapse of otomycosis. Clinical samples were taken by an ENT specialist from patients suspicious of having otomycosis. A part of these samples were stained, and others were cultured. The diagnosis of otomycosis was made on the basis of the recognizable and characteristic appearance of fungal hyphae or mycelium and fruiting bodies and/or conidiophores under microscopic examination. Patients with suspected otomycosis are not at risk of recurrence after treatment with clotrimazole drops. Out of the 161 individuals in whom definite diagnosis of otomycosis was made, the most affected individuals were, in the age range of 40-49 years, women, urban citizens, and housewives. Pruritus and diminished hearing were the main complaints of the patients. Aspergillus niger and A. flavus as well as Candida albicans were the main causes of the disease. The relapse of disease was observed in only five patients (3.1%), where A. niger was the main fungus. Most relapses were observed in women and in those with diminished hearing, manipulating the ears, ulcers in the canal, and tympanum. Our results suggested that usage of clotrimazole can be effective in reducing the relapse of otomycosis, and concerning the high cost of treating otomycosis while the low cost of using clotrimazole, usage of this drop is recommended to reduce the relapse of otomycosis.

Effect of combination therapy with ceftizoxime and clotrimazole in the treatment of otomycosis.

BACKGROUND AND PURPOSE: There are controversial findings regarding the efficacy of antifungal drugs in the treatment of a ruptured eardrum following fungal infections. Regarding this, the aim of the present study was to evaluate the therapeutic effect of the co-administration of antifungal and antibacterial agents in the treatment of otomycosis with tympanic membrane perforation. MATERIALS AND METHODS: This analytical, clinical trial was conducted on 87 patients with otomycosis showing no bacterial elements in the direct observation and culture. The study population was assigned into two groups of intervention (n=45) and control (n=42). The demographic and clinical data, as well as the data related to the direct observation and culture of the ear samples were recorded in a checklist. All statistical analysis was performed in SPSS (version 24). RESULTS: The most prevalent symptoms in both groups were hearing loss and itching, and the most common finding was secretion. Aspergillus and Candida were the most frequent fungi isolated from the samples. After the implementation of combination therapy, the intervention group demonstrated a significant decrease in symptoms and signs, compared to the control group (P=0.005). CONCLUSION: The findings of the present study indicated that the use combination therapy with ceftizoxime powder and clotrimazole ointment was effective the in treatment of the patients with tympanic membrane rupture showing no bacterial effects in direct examination and culture.

Bacterial Otitis Externa in Patients Attending an ENT Clinic in Babol, North of Iran.

BACKGROUND: Acute otitis externa, an inflammatory condition of the external auditory canal, is a common clinical problem in general medicine. OBJECTIVES: This study aimed to determine the etiology of otitis externa in patients from the Mazandaran province, north of Iran, which has a humid climate, as humidity can affect the prevalence of pathogenic microorganisms. PATIENTS AND METHODS: This cross-sectional study involved 116 patients with otitis externa. Two sets of samples were collected from their ears; one set was used for slide preparations, and the other for microbial culturing. After culturing, the microorganisms were identified by conventional methods. RESULTS: Patients between 35 and 44 years of age were most frequently affected (25.00%) by otitis externa (average age, 43.87 ± 18.08 years). Moreover, women (54.31%) were more frequently affected than men (45.69%). Upon direct investigation, Gram-positive bacilli were the most commonly identified microorganisms (22.41%). Furthermore, Bacillus spp. and coagulase-negative staphylococci (22.41% and 19.83%, respectively), were the organisms most frequently identified from cultures of otitis externa samples. CONCLUSIONS: Direct examination and culture showed that a mixed infection of fungi and bacteria is the most common cause of otitis externa. The present study revealed that Bacilli spp. were the most abundant bacteria isolated from patients with otitis externa. Thus, it is recommended that both organisms should be considered as etiologic agents in protocols for treatment of otitis externa.

Laryngeal tuberculosis without pulmonary involvement.

BACKGROUND: Tuberculosis of the larynx is a rare form of tuberculosis. Patients usually present with hoarseness or dysphagia and other nonspecific constitutional symptoms like fever or localized pain. In this study, we present a case of primary vocal cord lesion with tuberculosis. CASE PRESENTATION: A 72 year old man presented with hoarseness of voice, low grade fever, and night sweating with in three month duration. Laryncoscopic study showed unilateral thickening of vocal cord and biopsy of the lesion showed granuloma with caseous necrosis. Chest x-ray was normal. The patient was treated with standard regimen of tuberculosis and was cured after 6 months of therapy. CONCLUSION: Laryngeal tuberculosis should be considered in the differential diagnosis of patients with hoarseness without pulmonary involvement in endemic regions of tuberculosis.