Background The global spread of terbinafine‐resistant Trichophyton mentagrophytes with point mutations in the squalene epoxidase (SQLE) gene is a big concern. Aim The present study presents a series of unusual familial cases of generalized dermatophytosis caused by multidrug‐resistant T. mentagrophytes genotype VIII. Methods Initially, the skin samples of each patient were taken and then subjected to direct microscopy and culture in Mycosel Agar. The molecular identification of Trichophyton species (spp.) was performed for all family members. In addition, the immunologic tests were requested, and an antifungal susceptibility test was carried out using the broth microdilution protocol based on the Clinical and Laboratory Standards Institute M38, third edition. The SQLE gene for a terbinafine‐resistant T. mentagrophytes genotype VIII was sequenced and confirmed its nucleotide sequence to KU242352 as a susceptible strain. Results Based on the results of mycological examination and ITS rDNA sequencing, the etiologic agent was identified as T. mentagrophytes as a zoophilic dermatophyte. This species showed multiple drug resistance in vitro against terbinafine (minimum inhibitory concentration (MICs ≥8 µg/ml), itraconazole (MIC ≥4), and fluconazole (MIC ≥16). The SQLE gene of the isolate was subjected to sequencing for mutation, which showed a point mutation as TTC/TTA in the gene leading to Phe397Leu amino acid substitution in the enzyme. Only one of the family members responded to itraconazole and was cured after the long‐term use of itraconazole. Other family members were treated with oral voriconazole with no recurrence. Conclusion The transmission of this resistant T. mentagrophytes to other countries due to globalization is a serious issue to be considered.

Among the many related issues of diabetes management, its complications constitute the main part of the heavy burden of this disease. The aim of this paper is to develop a risk advisor model to predict the chances of diabetes complications according to the changes in risk factors. As the starting point, an inclusive list of (k) diabetes complications and (n) their correlated predisposing factors are derived from the existing endocrinology text books. A type of data meta-analysis has been done to extract and combine the numeric value of the relationships between these two. The whole n (risk factors) - k (complications) model was broken down into k different (n-1) relationships and these (n-1) dependencies were broken into n (1-1) models. Applying regression analysis (seven patterns) and artificial neural networks (ANN), we created models to show the (1-1) correspondence between factors and complications. Then all 1-1 models related to an individual complication were integrated using the naïve Bayes theorem. Finally, a Bayesian belief network was developed to show the influence of all risk factors and complications on each other. We assessed the predictive power of the 1-1 models by R2, F-ratio and adjusted R2 equations; sensitivity, specificity and positive predictive value were calculated to evaluate the final model using real patient data. The results suggest that the best fitted regression models outperform the predictive ability of an ANN model, as well as six other regression patterns for all 1-1 models.

Background Postoperative delirium is common in patients undergoing coronary artery bypass grafting, characterized by cognitive decline. This study aimed to evaluate the effect of early planned mobilization on delirium after coronary artery bypass grafting. Methods This double-blind randomized clinical trial enrolled 92 consecutive patients who underwent coronary artery bypass grafting from September to December 2018. The patients were divided into two groups of 46: a mobilization protocol was applied in the intervention group in the first 2 days after surgery; the control group received routine nursing care only. Demographic data, medical records, and Neecham confusion scores were analyzed. Results Patients in the control group used cigarettes (31.1% vs. 11.1%, p = 0.020) and opium poppy for recreation (35.6% vs. 8.9%, p = 0.002) more frequently, had longer intubation times (11.91 ± 3.87 vs. 10.23 ± 2.71 h, p = 0.020), and fewer blood components infused (15.6% vs. 33.3%, p = 0.05). More patients in the intervention group had normal function on the 2nd postoperative day compared to the control group (25 vs. 2, respectively, p = 0.001). The intervention group had significantly higher Neecham scores on postoperative day 2 (22.49 ± 2.03 vs. 26.82 ± 2.10, p = 0.001). Multivariable analysis showed significant associations between Neecham score and age ( p = 0.022), ejection fraction ( p = 0.015), myocardial infarction ( p = 0.016), systolic pressure ( p = 0.009), and diastolic pressure ( p = 0.008). Conclusions Early planned mobilization was effective in reducing postoperative delirium in patients undergoing coronary artery bypass grafting.

Background:This study was designed to determine the prevalence of concomitant anatomic variation of paranasal sinuses in patients with antrochoanal polyp (ACP).Materials and Methods:Among patients referred by their clinicians for standard computed tomography scan of paranasal sinuses septal deviation, concha bullosa, and retention cyst were evaluated in both patients with ACP as well as in a control group.Results:Of the 17 patients with ACP, fifteen patients (88.2%) had septal deviation and two patients (11.8%) had concha bullosa. None of the patients with ACP had retention cyst or hypertrophic turbinate. Of the 78 patients in control group, twenty-nine (37.2%) had septal deviation, six (7.7%) had concha bullosa, seven (8.9%) had retention cyst, and one (1.2%) had hypertrophic turbinate. Septal deviation in patients with ACP has higher incidence (P < 0.001).Conclusion:This study showed that septal deviation is an anatomic variation which is significantly concomitant with ACP. Larger studies are needed to show the role of other anatomic variations in patients with ACP.

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Introduction: SARS-CoV2 (COVID-19) is a serious and global infection that has spread to numerous countries, including Iran. Pneumothorax may occur in cases of COVID-19 as a consequence of lung parenchymal damage, which can disrupt the healing process and increase mortality. Case Presentation: This manuscript describes the case of a 2-year-old boy with hyper IgM syndrome and COVID-19 infection. The patient developed spontaneous pneumothorax and recovered without chest tube by supportive care and was discharged in good general condition after the completion of the antibiotic course and cessation of fever. Conclusions: The severity, prognosis, and best treatment for spontaneous pneumothorax in COVID-19 infection, especially in children, remain nebulous. It is recommended that conservative treatment be performed if the patient has stable vital signs and no severe respiratory failure. However, this requires more detailed clinical evaluations.

The introduction of polymerase chain reaction (PCR) techniques has improved the detection of respiratory viruses, particularly with the use of multiplex real-time technique with the capability of simultaneous detection of various pathogens in a single reaction. The aim of this study was to apply the above technology for the diagnosis of influenza infections and at the same time to differentiate between common flu species between hospitalized patients in Laleh hospital (Iran) between two flu seasons (2016- 2017 and 2017-2018). Different respiratory specimens were collected from 540 patients from a period of December 2016 to May 2018 and were sent to the laboratory for molecular diagnosis. RNAs were extracted and subsequently, a multiplex real time PCR identifying flu A, flu B and typing flu A (H1N1) was carried out. The mean age of patients was 47.54±23.96. 216 (40%) and 321 (60%) of subjects were male and female, respectively. 219 out of 540 (40.5%) were positive for influenza infection including flu A (n=97, 44.3%), flu A (H1N1) (n=45, 20.7%) and flu B (n=77, 35%). Flu A was the dominant species on 2016-2017 and flu B was the major species on 2017-2018. Flu A (H1N1) was comparable in both time periods. Flu infections were most frequently diagnosed in age groups 21-40. Flu-positive patients suffered more from body pain and sore throat than flunegative patients with significant statistical difference (P values <0.001). The mean duration of hospitalization was shorter for flu-positive patients (P value = 0.016). Application of multiplex real time PCR could facilitate the influenza diagnosis in a short period of time, benefiting patients from exclusion of bacterial infections and avoiding unnecessary antibiotic therapy. Influenza diagnosis was not achieved in up to 60% of flu-like respiratory infections, suggesting the potential benefit of adopting the same methodology for assessing the involvement of other viral or/and bacterial pathogens in those patients.

Objectives: This study aimed to investigate the spectrum of bacterial pathogens and their antimicrobial sensitivity in pediatric patients admitted with febrile neutropenia (FN) and hematologic malignancies. Methods: This prospective, cross-sectional study was carried out on 65 children (60% boys, mean age 7.3 5.3 years) with hematologic malignancies and FN hospitalized at the Amir Hematology and Oncology Hospital, Shiraz, Iran, between December 2018 and May 2019. Samples were taken from blood, nose, axilla, and inguinal area (NAI). NAI cultures were repeated after 72 hours of admission, and blood culture was repeated if needed. A demographic questionnaire on age, sex, and admission time was filled out for each patient. Results: The most common grown bacteria in the NAI samples were coagulase-negative staphylococci (CoNS). Second cultures from these sites revealed nosocomial contamination. Eighteen patients (27.7%) had positive blood cultures, with 61.1 % of the isolated pathogens being Gram-negative (mostly Escherichia coli and Pseudomonas aeroginosa) and 38.9% Gram-positive. The blood cultures results did not match those of the NAI cultures in 61.1% of the patients. About one-fourth of the Gram-negative pathogens isolated from blood were resistant to cefepime, the main empirical antibiotic for FN management at our center. Conclusions: Gram-negative bacteria are predominant organisms in pediatric FN patients at our center, most resistant to cefepime. If a similar antimicrobial sensitivity pattern is observed in future studies, a change in local guidelines might be considered for FN management.