Diagnosis of Behcet's disease in a young male patient with acute bilateral pulmonary embolism; A case report and literature review

Behcet's disease (BD) is a chronic and inflammatory vasculitis characterized by recurrent oral and genital aphthous ulcers, uveitis, and skin lesions. Although there is a high rate of deep vein thrombosis in BD, pulmonary arterial thromboembolism (PTE) is a rare complication. We present a 30-year-old patient who was admitted with pleuritic chest pain, non-massive hemoptysis since 4 days ago and medical history of intermittent genial aphthous lesions, and skin lesions. During our evaluation, he had an S1Q3T3 pattern in the electrocardiogram, a high level of D-dimer, a low level of FDP and fibrinogen along with pulmonary emboli in lobar and segmental branches of the right pulmonary artery and segmental branches of left lower lobe pulmonary artery were detected in his pulmonary CT Angiography. Then, he was positive for HLA-B51. Based on his clinical condition and history of recurrent genital and skin lesions, a positive pathergy test. Therefore, the diagnosis of BD was confirmed for him. Diagnosis of PTE can be difficult due to the rarity of PTE in BD and nonspecific clinical symptoms; therefore, a high degree of suspicion and appropriate radiographic imaging is essential for the diagnosis.

The co-infection of pulmonary hydatid cyst, lophomoniasis and tuberculosis in a patient with resistant respiratory symptoms; a case report study

BACKGROUND

Lophomonas blattarum is a rare protozoan that causes opportunistic infections, and the co-infection of lophomonas with tuberculosis and human hydatidosis is a serious public problem in the co-endemic areas of developing countries.

CASE REPORT

We presented a 58-year-old female with fever, losing weight, and cough with whitish-yellow sputum that started one month ago. Increasing inflammatory markers and hypereosinophilia in laboratory tests, and a cavity with thick, regular walls and undulating air-fluid levels measuring 43 × 30, evident in the upper segment of the right lower lobe (RLL), along with consolidation and the ground glass opacity of the upper segment and posterior basal of the RLL is apparent in CT scan were reported. Then, a bronchoscopy was requested, and the BAL specimen reported a negative fungal and bacterial infection in the samples. Several live and oval flagellated lophomonas protozoa, hydatid cyst protoscoleces (the larval forms of the parasites), and M. tuberculosis were observed in microscopic evaluation. The patient was treated with metronidazole, oral albendazole, and a combination of TB regimen.

CONCLUSION

Physicians should always consider the possibility of co-infections of lophomonas with tuberculosis and human hydatidosis and investigate patients with risk factors such as immunodeficiency conditions or treated with immunosuppressive medications.

Does the ketogenic diet improve neurological disorders by influencing gut microbiota? A systematic review

BACKGROUND

The aim of this systematic review is to evaluate the changes in gut microbiota (GM) induced by the Ketogenic Diets (KD) as a potential underlying mechanism in the improvement of neurological diseases.

METHODS

A comprehensive search was conducted on three electronic databases, including PubMed/Medline, Web of Science, and Scopus until December 2022. The inclusion criteria were studies that described any changes in GM after consuming KD in neurological patients. Full text of studies such as clinical trials and cohorts were added. The quality assessment of cohort studies was conducted using the Newcastle-Ottawa Quality Assessment Scale and for the clinical trials using the Cochrane Collaboration tool. The search, screening, and data extraction were performed by two researchers independently.

RESULTS

Thirteen studies examining the effects of the KD on the GM in neurological patients were included. Studies have shown that KD improves clinical outcomes by reducing disease severity and recurrence rates. An increase in Proteobacteria phylum, Escherichia, Bacteroides, Prevotella, Faecalibacterium, Lachnospira, Agaricus, and Mrakia genera and a reduction in Firmicutes, and Actinobacteria phyla, Eubacterium, Cronobacter, Saccharomyces, Claviceps, Akkermansia and Dialister genera were reported after KD. Studies showed a reduction in concentrations of fecal short-chain fatty acids and branched-chain fatty acids and an increase in beta Hydroxybutyrate, trimethylamine N-oxide, and N-acetylserotonin levels after KD.

CONCLUSION

The KD prescribed in neurological patients has effectively altered the GM composition and GM-derived metabolites.

Understanding the management of pediatric spondylodiscitis based on existing literature; a systematic review

BACKGROUND

Spondylodiscitis (SD), a rare disease in children, poses diagnostic challenges due to non-specific presenting symptoms, scarcity in incidence, and difficulty expressing pain in non-verbal children.

METHOD

A comprehensive search was conducted on three databases, including PubMed/Medline, Web of Science, and Scopus until March 2023. The inclusion criteria were studies that investigated the clinical characteristics, treatment, and complications of children's spondylodiscitis. Full text of cross-sectional and cohort studies were added. The quality assessment of cohort studies was conducted using the Newcastle-Ottawa Quality Assessment Scale. The search, screening, and data extraction were performed by two researchers independently.

RESULT

Clinical manifestations of discitis in children are nonspecific, such as back pain, fever, reduced ability or inability to walk or sit, limping, and reduced range of movements. The mean delay in the time of diagnosis was 4.8 weeks. The most affected site of all the studies was the lumbar spine. 94% of studies reported increased inflammatory markers such as white blood cell count, C-reactive protein, and erythrocyte sedimentation rate. Less than 30% of patients had positive blood cultures and biopsy findings. The most common microbiological results (64%) were Staphylococcus Aureus and Kingella kingae. In radiographic evaluation, intervertebral disk narrowing, lumbar lordosis reduction, loss of disk height, and destruction of the vertebral body have been reported. In all studies, antibiotic therapy was initiated; in 52% immobilization was employed, and 29% of studies reported surgery was performed, and the follow-up period differed from 1.5 months to 156 months. 94% of studies reported complications such as vertebral body destruction, back pain, kyphosis, reduced range of movement, scoliosis, and neurological complications.

CONCLUSION

Spondylodiscitis is an uncommon, heterogeneous, multifactorial disease with resulting difficult and delayed diagnosis. Due to its morbidity, it is essential to investigate children with refusal to walk, gait disturbances, or back pain, particularly when associated with elevated inflammatory markers.

Evaluation of cardiac diagnostic tests findings based on pro-BNP levels in COVID-19 pregnant patients

BACKGROUND

Pro-b-type natriuretic peptide (Pro-BNP) is an inflammatory marker that indicates cardiac damage and inflammation. The elevation of this marker in COVID-19 patients can be used as a predictive factor in the prognosis of these patients.

METHOD

Our cross-sectional study investigated the evaluation of cardiac diagnostic test findings based on pro-BNP levels in pregnant COVID-19 patients in Sayyad Shirazi Hospital, Gorgan, Iran, in 2020-2022. A hundred and ten pregnant patients diagnosed with COVID-19 infection were evaluated for cardiac diagnostic tests (electrocardiogram (ECG) and echocardiography (Echo)) and pro-BNP levels. Data were analyzed using SPSS 25 software. Chi-square and Student's t-test will be used to test and compare the relationship between variables and compare them. A P-value less than 0.05 is considered statistically significant. The chi-square test was used to compare the ratio of qualitative variables among the groups if the presuppositions of chi-square distribution were established. Otherwise, Fisher's exact test was used.

RESULT

The mean age of participants were 31.06 ± 5.533 years and 49.1% of patients had pro-BNP levels above the cut-off value for predicting an adverse outcome of COVID-19. The mean ± standard deviation of pro-BNP levels in the low group was 46.125 ± 17.523 pg/mL and in the high group was 878.814 ± 1038.060 pg/mL. This study revealed that patients with higher pro-BNP plasma levels had a significant relation between, myocardial infarction (MI), pericardial effusion (PE), urgent Caesarean section (C/S), and mortality. In addition, no significant relation between gravid, trimester, vaccination, arrhythmia, heart block, and valves diseases with high pro-BNP levels was found.

CONCLUSION

The current research showed that pro-BNP levels can be used as a diagnostic and valuable prognostic tool in pregnant women to diagnose cardiac complications by using ECG and Echo.

Evaluation of Awareness and Attitude of Telemedicine among Primary Healthcare Workers in Deprived Area Health Centers

Background

Telemedicine has the potential to make healthcare more efficient, organized, and available and is a more beneficial technology that can ease preventive treatment and improve long-term health management. This is especially essential for those who face financial or regional reasons to get quality treatment. Telemedicine in Iran is a new medical field and a noble way to access medical facilities for populations living in deprived areas, and the primary healthcare workers in these deprived medical centers are the implementers of telemedicine in those areas; we aimed to investigate the awareness and attitude towards telemedicine among all the healthcare workers in these centers.

Method

This is a descriptive cross-sectional study at the Health Centers of Raz County in North Khorasan Province, Iran, and 149 healthcare workers were included. For collecting information, we used a questionnaire that consisted of two parts. The first part contains the demographic data of health care workers, and the second part includes the 5-point Likert scale questionnaire (questions on telemedicine awareness, attitude, and self-report readiness).

Result

Most participants (51%) were male, and 69.8% were married. The most frequent sources of information about telemedicine are colleagues (40.3%), continuing education (24.7%), and social media and the internet (10.1%). Awareness did not significantly relate to gender, age, marital status, or work experience, but awareness of physicians and midwives is higher than other groups (p < 0.05). The awareness of healthcare workers using continuing education, articles, workshops, or conferences was significantly higher (p < 0.05). The attitude scores for most questions are above 3.4 and reflect a positive attitude about telemedicine. Attitudes did not show a significant relation to gender, age, marital status, or work experience.

Conclusion

Using telemedicine in developing countries, rural or urban areas have a high potential to improve epidemiological investigations, disease control, and clinical case management. Providing healthcare professionals with more information about new technologies in healthcare, such as telemedicine, can help get a more realistic picture of their perceptions.

The comorbidity of somatic symptom and major depressive disorders in the times of COVID-19 lockdown in adolescence: A case-report study

Physical symptoms with normal clinical examinations have been reported without detectable structural or biochemical abnormalities in the comorbidity of somatic symptom disorder and major depressive disorder. This association can have a debilitating effect on their academic and social performance. This case report is about a 13-year-old Afghani immigrant boy with no previous psychiatric history who developed severe body pain leading to a disability during the COVID-19 lockdown and social isolation. During further evaluation, all his clinical examinations were normal, and the diagnosis of major depressive disorder and somatic symptom disorder was confirmed. Cognitive behavioral therapy includes cognitive therapy, changing lifestyle, and a motivational support method. Medical treatment with olanzapine, fluvoxamine, and gabapentin was started. During follow-up, there was improvement in the patient's mood, and the patient began to walk and communicate. It is important to suspect an association of somatic symptom disorder and major depressive disorder in patients with severe body pain and multiemotional factors. Psychiatrists should keep in mind that emotional factors can play a significant role in causing and maintaining physical symptoms.

Acute Hepatitis A and Hepatitis B Coinfection in a Young Female: A Case Report and Literature Review

Background

Hepatitis is one of the common infectious diseases that can infect patients in various forms. Based on their characteristics and clinical features, they can cause irreparable complications in patients. Coinfections and superinfections between its variant have been reported, but the coinfection of acute HAV and HBV is rarely reported. Case Presentation. In this case report, we presented a case with severe malaise, nausea, vomiting, generalized jaundice, and a history of recent tattooing and travel to the HAV endemic area. In our evaluation, she had a positive HBsAg, HBeAg, anti-HBs IgM, anti-HAV IgM, and negative result in HCV antibody, HIV antibody, and anti-HAV IgG. The coinfection of HAV/HBV was confirmed for her.

Conclusion

Physicians should differentiate hepatitis A and hepatitis B superinfection or coinfection, based on history and laboratory testing, to prevent complications with appropriate treatment.

A Newborn with Extremely Rare Cerebro-Costo-Mandibular Syndrome; A Case Report Study

BACKGROUND

Cerebro-costo-mandibular syndrome (CCMS) is a rare congenital syndrome consisting of the main features of micrognathia and posterior rib gaps. Due to multiple abnormalities, patients almost have difficulty breathing with upper airway obstruction, decreased thoracic capacity, spina bifida, and scoliosis.

CASE PRESENTATION

We describe a case of a late preterm neonate boy presenting with low Apgar, respiratory distress, and complicated orofacial anomalies that had a poor outcome. His radiographic findings showed mandibular hypoplasia (micrognathia), chest deformity, multiple posterior rib gap defects, and abnormal costotransverse articulation. Based on physical examination and radiologic findings, the diagnosis of CCMS confirmed for the patient.

CONCLUSION

Physicians should always consider the diagnosis of CCMS in all infants with micrognathia and rib-gap defects. These infants need careful respiratory function monitoring. Early airway management improves growth and development. In addition, their physical and psychological development should be assessed regularly.

A Rare Case of Pulmonary Adenocarcinoma in an 8-Year-Old Patient with Persistent Respiratory Manifestation: A Case Report Study

Pulmonary adenocarcinoma is an extremely infrequent cancer in children. This cancer usually presents with unspecific manifestations that lead to delays in diagnosis. The treatment protocol for adenocarcinoma in children remains challenging due to its rarity. We presented an 8 years old with a chief complaint of a non-purulent cough, dyspnea, hemoptysis, and weight loss. Decreased lung sounds and wheezing in the left lung were heard during auscultation. The radiographic evaluation showed a mediastinal mass in the left middle upper. A biopsy was performed, and adenocarcinoma was reported. Based on being at stage 1, a lobectomy was the proper treatment for her. Although adenocarcinoma is rare in pediatrics, we suggested that physicians consider taking chest X-rays in patients with persistent respiratory manifestations, especially those with critical symptoms. Early detection leads to diagnosing patients in lower stages, which results in a good prognosis and better treatment outcomes.

How did lockdown and social distancing policies change the eating habits of diabetic patients during the COVID-19 pandemic? A systematic review

Background

After the declaration of the COVID-19 pandemic, governments established national lockdowns and social distancing as an effective plan to control this disease. As a result of the lockdown policies, diabetic patients` access to food products, medication, and routine follow-ups is disrupted, making it difficult for them to control their disease.

Methods

International databases, including PubMed/Medline, Web of Science, and Scopus, were searched until April 2022. All observational studies included assessing the impact of lockdown and social distancing on eating habits (as primary outcome), and glycemic and anthropometric indices (as secondary outcomes) of diabetic patients during the COVID-19 pandemic. The Newcastle-Ottawa Quality Scale was used to assess the quality rating of the studies.

Results

Overall, 22 studies were included in this systematic review, the results of which varied in different communities. In most studies, consumption of grains, fruits, and vegetables was reported to increase. On the other hand, consumption of snacks and sweets was reported to increase in other surveys. During the COVID-19 lockdown, most diabetic patients preferred to cook meals at home, using less takeout, fast foods, and alcoholic drinks. Although the patients mostly improved their eating habits, the glycemic and anthropometric indices were contradictory in different studies. Studies showed that the eating habits of diabetic patients vary from country to country, even in some cases and studies done in the same country showed different results. For example, all the studies done in Japan showed an increase in the consumption of snacks and sweets, leading to weight gain in the patients. However, conflicting results in eating habits have been observed in studies conducted in India.

Conclusion

The lockdown policies have led to a beneficial change in the eating habits of diabetic patients to consume more fruits and vegetables and reduce the consumption of animal protein products and alcoholic beverages. While some diabetic patients have increased consumption of snacks and sweets, leading to a disturbance in their glycemic and anthropometric indices control. Understanding the consequences of lockdown and social distancing of the diabetic patient during the COVID-19 pandemic can help public health authorities make better recommendations to improve glycemic control.