Background Brucellosis is among the most widespread zoonotic diseases worldwide. Although rare, nervous system involvement due to Brucella infection is a major diagnostic challenge in endemic regions. Patients and methods This study was a cross-sectional investigation of hospitalized adults with neurobrucellosis from March 2007 to February 2017. We described the clinical characteristics, radiographical and laboratory features, and clinical outcomes of patients with neurobrucellosis. Results Fifty-four patients with neurobrucellosis were included. The median age was 35 (interquartile range, 25–50) years, and 32 (59%) cases were male. Thirty-four (63%) patients were stockmen or shepherds. The most common clinical manifestations were fever in 49 (91%) cases, headache in 47 (87%), decreased consciousness in 12 (22%), and seizures in 6 (11%). Meningeal signs were detected in 36 (67%) cases. Brucella species were isolated in five cases from blood or cerebrospinal fluid (CSF). The median of CSF leukocytes was 75 per µL, CSF protein 83 mg/dL, and CSF glucose 39 mg/dL. Only two cases had severe hypoglycorrhachia and one CSF protein ≥ 500 mg/dL. No patient died during hospitalization. Conclusions The symptoms of neurobrucellosis could be mild and nonspecific and the classic triad of meningitis is uncommon. Mild CSF pleocytosis of fewer than 50 leukocytes per microliter of CSF was common but severe hyperproteinorrhachia and severe hypoglycorrhachia were rare in neurobrucellosis. Differentiation between neurobrucellosis and systemic brucellosis is important, because more prolonged treatment is indicated for neurobrucellosis, and it could be associated with a broad spectrum of complications that require close follow-up.
Considering the outbreak pandemic of Coronavirus Disease 2019 (COVID‐19), the lack of effective therapeutic strategies for the management of this viral disease, and the increasing evidence on the antiviral potential of silymarin, this study aimed to investigate the effectiveness of silymarin nanomicelles on the symptom's resolution time, laboratory parameters, and liver enzymes in patients with COVID‐19. The participants were assigned to the nano‐silymarin ( n = 25) (receiving SinaLive soft gel, containing 70 mg silymarin as nanomicelles) or placebo groups ( n = 25) three times daily for two weeks. Patients' symptoms and laboratory findings were assessed at baseline and during the follow‐up period (one week and one month after the beginning of the treatment). No significant differences were observed between the two groups in terms of symptoms resolution time, laboratory parameters, and hospitalization duration ( p > 0.05). However, the alanine aminotransferase level decreased significantly in the treatment group, compared to the placebo group ( p < 0.001). Concomitant use of dexamethasone and remdesivir with silymarin might make the effects of silymarin on the improvement of patients' condition unclear. Further clinical trials are recommended with diverse dosages and larger sample sizes.
Background and aim: The main challenging issue about coronavirus disease 2019 (COVID-19) is the production of safe and stable vaccines, which is a very long process. Due to the emergency situation, regular and extensive screening of available and traditional drugs, which are commonly used for the treatment of similar viral diseases, can be a reasonable option. The present study aimed to compare the administration of hydroxychloroquine (HCQ) plus arbidol to the use of HCQ alone in the treatment of COVID-19 infection. Methods and Materials: This single-blind randomized controlled trial was carried out on a total of 100 patients with COVID-19 referring to the infection ward of Imam Reza Hospital in Mashhad, Iran, in 2020. The patients were randomly assigned to two HCQ alone and HCQ plus arbidol groups. Results: According to the obtained results, hematological parameters, including white blood cell count, hemoglobin level, lymphocyte count, and platelet count, improved in patients with COVID-19 after the treatment with both HCQ plus arbidol and HCQ alone (P<0.005). The mean values of the reduction time of C-reactive protein (CRP) were4.48±1.24 and 8.22±2.08 days in the arbidol and HCQ alone groups, respectively, indicating that CRP decreased faster in the arbidol group than that reported for the HCQ alone group (Z=0.-7.85; P<0.000).The mean scores of hospital stay were reported as 5.89±2.04 and 9.35±3.72 days in the arbidol and HCQ alone groups, respectively (Z=-4.31; P<0.005). All the patients in the arbidol group survived; while 6% of the subjects in the HCQ alone group died. In addition, the drug regimen was not changed for any patient, and no subject was transferred to the intensive care unit in the arbidol group. Conclusion: In summary, the administration of both arbidol and HCQ leads to the improvement of the hematological parameters. The present study introduced arbidol as an effective treatment for moderate to severe patients with COVID-19, which not only reduced the time of CRP normalization level but also decreased the hospitalization duration and mortality compared to those reported for HCQ.
Background: Infectious diseases are commonly missed or misdiagnosed. Errors in diagnosing infectious diseases not only affect the patient but also the community health.Objectives: To describe our investigation on the most common errors in diagnosing infectious diseases and their causes according to the physicians' reports.Methods: Between August 2018 and February 2019, specialist physicians and residents across Mashhad, Iran were invited to participate in a survey to report errors they had made or witnessed regarding the diagnosis of infectious diseases.Results: Overall, 465 cases were reported by 315 participants. The most common infectious diseases affected by diagnostic errors were upper respiratory tract infections (URTIs) (n = 69, 14.8%), tuberculosis (TB) (n = 66, 14.1%), pleuro-pulmonary infections (n = 54, 11.6%), central nervous system (CNS) infections (n = 51, 10.9%), and urinary tract infections (n = 45, 9.6%). Errors occurred most frequently in generating a diagnostic hypothesis (n = 259, 55/7%), followed by history taking (n = 200, 43%), and physical examination (n = 191, 41/1%). Errors related to the diagnosis of TB (odds ratio [OR]: 2.4, 95% confidence interval [CI]:0.9–5.7; P value: 0.047) and intra-abdominal infections (OR: 7.2, 95% CI: 0.9–53.8; P value: 0.02) were associated with more-serious outcomes.Conclusion: A substantial proportion of errors in diagnosing infectious diseases moderately or seriously affect patients' outcomes. URTIs, TB, and pleuropulmonary infections were the most frequently reported infectious diseases involved in diagnostic error while errors related to the diagnosis of TB and intraabdominal infections were more frequently associated with poor outcomes. Therefore, contagious and potentially life-threatening infectious diseases should always be considered in the differential diagnosis of patients who present with compatible clinical syndromes.
Background Globally, the overall incidence of infections due to nontuberculous mycobacteria and their burden of illness have been steadily increased during the last decade. Although a rare entity, Mycobacterium simiae is among the most common slow-growing species of nontuberculous mycobacteria in some geographic regions, including Iran. Methods We analyzed individuals who were diagnosed with pneumonia due to M. simiae between March 2004 and September 2019 in Mashhad, Iran. All patients were followed up for their survival until the end of the study. We described the clinical, laboratory, and radiographic features as well as long-term clinical outcomes of patients with pneumonia due to M. simiae. Results The mean age of patients with M. simiae infection was 63 years (interquartile range, 48–71 years), and 12 cases (71%) were female. The median time from symptom onset to diagnosis was 17.6 months. Sixteen patients (94%) were initially misdiagnosed as pneumonia due to Mycobacterium tuberculosis. Lung radiography revealed bronchiectasis in 14 (82%), nodules in 12 (71%), and cavities in 8 (47%), with bilateral involvement in 13 (77%) and upper and middle zones involvement in 5 (29%). All patients were treated with a 3-drug combination of clarithromycin, trimethoprim-sulfamethoxazole, and ofloxacin or moxifloxacin. At a median period of 21-month follow-up, 5 patients (29%) had incomplete or lack of response to treatment, of whom 2 (13%) died. Conclusions Delayed diagnosis is common in M. simiae pulmonary disease due to frequent misdiagnosis with pulmonary tuberculosis. Treatment of M. simiae infection is associated with a high rate of treatment failure and poor outcomes. More extensive pulmonary disease at the time of diagnosis and pretreatment with antituberculous medication due to initial misdiagnosis might affect treatment outcome.
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