Fatality Case in a Tuberculous Meningoencephalitis Patient Coinfected with COVID-19

: Tuberculous meningoencephalitis (TBM) is the most severe, life-threatening form of tuberculosis that contributes to as much as 5% of cases of extrapulmonary tuberculosis. Emerging at the end of 2019, COVID-19 has been shown to affect various organs, including the brain. In this case report, a 21-year-old woman diagnosed with TBM, being in the intensive phase of tuberculous therapy, came with dysphagia and dysphonia as new complaints felt one day before admission accompanied by a positive meningeal sign, diplopia, and cephalgia, which became heavier after previously getting better. Cough and fever followed this complaint two days before admission. About the laboratory results, the PCR was positive for COVID-19, and CT scans showed increased leptomeningeal enhancement when compared with CT scan one month earlier. The patient received intravenous dexamethasone, anti-tuberculosis drugs, phenytoin, aspirin, oseltamivir, and hydroxychloroquine. The patient died four days after being hospitalized due to respiratory failure. This case report shows the coinfection of COVID-19 and TBM resulting in a poor tuberculosis treatment response and outcome.

Seroprevalence and Associated Risk Factors of Toxoplasma Gondii Among Pregnant Women in Southwest Iran

Background: Acute Toxoplasma gondii infection during pregnancy period can cause congenital toxoplasmosis. The aim of this study was to assess the seroprevalence rate of immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies against T. gondii infection during pregnancy and the associated risk factors in southwest Iran. Methods: This study was performed on 88 pregnant women from October to December 2019 in Khorramshahr County, Khuzestan province, Iran. Anti-T. gondii IgG and IgM antibodies were tested through enzyme-linked immunosorbent assay (ELISA) method. Results: Following serological assays, 38.63% (34/88) and 2.27% (2/88) serum samples were positive for IgG and IgM antibodies, respectively. Also, a statistically significant association was observed between IgG seroprevalence and drinking of unpurified water (P = 0.015). Conclusions: The serological evidence revealed that pregnant women of southwest Iran had moderate exposure to T. gondii parasite. Since the risk of acquiring acute toxoplasmosis in pregnant women is clinically important, we highly recommend regular screening tests for T. gondii infection during pregnancy period.

Epidemiology and Clinical Outcomes of Patients with Confirmed Influenza in Mashhad, Iran in 2019

Background: Influenza is a contagious and acute viral disease caused by influenza viruses involving upper and lower respiratory tract system, especially in the cold seasons. Children aged less than 5 years old, elderly people, immunocompromised patients, pregnant women, and people with certain health conditions are at a higher risk for the disease and severe complications. Objectives: Due to the serious complications of influenza in certain groups, it is important to know which group of people are more at risk and need prevention strategies. This study aimed to investigate the patients with confirmed influenza, identify the people who are at a higher risk for infection, and assess the clinical outcomes of disease among patients. Methods: In this cross-sectional and descriptive study, we studied the files of all patients with confirmed influenza referred to the health centers in Mashhad, Iran, during autumn and winter of 2019 when influenza virus was prevalent. The disease was confirmed by reverse transcription polymerase chain reaction (RT-PCR) method. We studied all registered data related to the flu, including gender, age, residency, history of vaccination, risk factors, complications, and clinical outcomes. Results: In this study, 2977 patients (3% outpatients vs. 97% hospitalized) with flu like syndrome were tested by RT-PCR for influenza. Out of 84 outpatients, only two cases were positive for influenza. Among hospitalized patients, 80 cases (51% male vs. 49% female; age range: 1 - 87 years) had a positive RT-PCR test, and influenza type A was seen in 95% of cases. Pneumonia was the most common complication. Death happened in 29 (35.36%) patients and three (33.33%) cases with risk factors. The highest number of influenza patients (31 [37.8%]) had been reported from district No. 3 of Mashhad municipality, which is a crowded place and near the holy shrine. Conclusions: The results showed a high prevalence of complication and death among hospitalized patients, especially among those who did not have a risk factor for influenza viruses. Comprehensive vaccination programs and promotion of knowledge about transmission routes are two important measures for disease prevention and lower death rates.

Low Occurrence of Virulence Determinants in Vancomycin-Resistant Enterococcus from Clinical Samples in Southwest Nigeria

Background: The virulence factors of enterococci play a major role in the pathogenicity of enterococcal strains. Objectives: This study aimed to evaluate virulence factors and detect selected virulence and resistance genes in vancomycin-resistant Enterococcus (VRE) from clinical samples from southwest Nigeria. Methods: The VRE isolates (n = 85) recovered from clinical samples were characterized using conventional microbiology techniques, and molecular identification was made with ddlE primers. Phenotypic screening for five virulence determinants and detection of virulence and resistance genes using a polymerase chain reaction were carried out. Results: Phenotypic identification revealed 61 Enterococcus faecium and 24 Enterococcus faecalis. All the isolates hydrolyzed bile. Moreover, 88.2% of the isolates produced biofilm; however, 72.9% of the isolates produced gelatinase enzyme. Altogether, six isolates (7%) produced all five virulence factors. The least virulence factor expressed by the two species E. faecium and E. faecalis was DNase at 21.3% and 29.2% followed by cytolysin at 27.9% and 41.7%, respectively. Only 25 isolates (29.4%), including 23 E. faecium (37.7%) and only 2 (8.3%) E. faecalis isolates, revealed bands with molecular identification. Additionally, VRE isolates showed bands for asa1 (16%); only 1 (4%) isolate had the hyl gene and vanB gene, respectively. Conclusions: The absence of vanA and low detection of vanB resistance genes suggest the possible presence of other van types and emphasizes the need for further investigations on the incidence of other van genes using molecular screening methods in enterococci isolates in Nigeria for surveillance purposes. Moreover, the low occurrence of virulence genes implies that there might be other mediators of pathogenicity involved in Enterococcus virulence traits.

Acute and Massive Aortic Thrombosis and Embolic Occlusion in a Patient with COVID-19: A Case Report

: A 73-year-old man with a history of COVID-19 infection from two weeks ago was referred to the Emergency Department with a complaint of colicky and generalized abdominal pain in addition to prior respiratory symptoms. High-resolution Computed Tomography (HRCT) displayed the typical signs of COVID-19 pneumonia. Initially, laboratory tests showed increased C-reactive protein and severe leukocytosis. Because of generalized abdominal pain, spiral abdominal and pelvic CT scans were done, which showed massive irregular and free-floating aortic thrombosis from the carina site to the Superior Mesenteric Artery (SMA) detachment, indicative of acute and life-threatening thrombosis. Filling defects were seen in the middle and distal part of the splenic artery, indicating the embolic occlusion of the splenic artery. The patient was admitted to the Intensive Care Unit (ICU), and he became a candidate for conservative treatment because of the wide extension of thrombosis. Therefore, we should pay more attention to the indirect signs of thrombosis in patients with COVID-19 infection with gastrointestinal symptoms and consider anticoagulant therapy for high-risk patients with COVID-19. The unique feature of our case was acute and extensive arterial thrombosis.

Operative Management and Disposal of Hospital Wastes: A Comprehensive Appraisal

: Health clinics are significant destinations for the creation of risky waste. Every clinic has its own profile for the management and transport of waste contingent upon its area. It is amazingly crucial to guarantee that the waste created in medical clinics is sufficiently kept away from dangers to well-being and the climate. The manuscript describes the control of clinical waste, which incorporates infectious waste, synthetic substances, lapsed medications, radioactive trash, and rough waste are the major ones in hospitals. On the off chance that the administration is not efficient, it becomes perilous, as they are pathogenic and environmentally unsafe. Inability to do so can bring about negative results; for example, genuine well-being chances and the clinic's standing. This article portrays the different ways to deal with the powerful administration of clinic squander. The authors conclude that pretreatment is basic before discarding emergency clinic squander in a hospital to minimize hazardous issues.

Investigating the Antimicrobial Effects of Glycyrrhiza glabra and Salvia officinalis Ethanolic Extract Against Helicobacter pylori

Background: One of the most common gastrointestinal infections is Helicobacter pylori infection, which leads to gastritis, gastrointestinal ulcers, and eventually stomach cancer. Many chemical drugs are used to eradicate this bacterium; however, resistance to many drugs and recurrence of infection are some treatment problems. Among these, the role of herbal medicines is very important. Glycyrrhiza glabra and Salvia officinalis are some plants used to treat H. pylori infections. These plants grow in different regions of Iran, and it is important to study their effects on this bacterium. Objectives: Accordingly, this study aimed to isolate H. pylori strains and investigate the antimicrobial effects of G. glabra and S. officinalis ethanolic extract against this bacterium. Methods: H. pylori specimens were isolated from endometrium biopsy of the stomach of patients who referred to Sistan and Baluchestan Hospital by culture method. Then, the antimicrobial effects of the ethanolic extracts of G. glabra and S. officinalis were investigated on H. pylori isolates by microdilution method. Results: The results of this study showed that 30 (60%) cases were metronidazole-resistant, 15 (30%) were amoxicillin-resistant, 12 (24%) were tetracycline-resistant, and 2 (4%) were clarithromycin-resistant. While the lowest minimum inhibitory concentration (MIC) of G. glabra ethanolic extract against H. pylori was 3.1 mg/ml (five strains were inhibited), the highest minimum bactericidal concentration (MBC) was equal 100 mg/ml (six strains were inhibited). The lowest MIC of S. officinalis against H. pylori was equal 3.1 ppm (12 strains were inhibited), while the highest MBC was 50 ppm (one strain was inhibited). Conclusions: According to our results, G. glabra and S. officinalis ethanolic extracts had high antibacterial activity against antibiotic-resistant strains. Regarding the continuous and reckless use of chemical drugs, unfortunately, increasing drug resistance in germs is increasing compared to chemical drugs day by day, as a result, be used from medicinal herbs. On the other hand, as the environment (weather and soil area) is effective in the type and amount of phytochemical substances, therefore, it is suggested that when using a medicinal plant for the treatment of diseases, should be addressed to the location of the plant and the type of tissue of the plant to achieve the best Therapeutic effect.