The rate of osteoporotic hip fracture was relatively low in southern Iran. However, by aging population, this rate will increase and health policy makers should implement targeted osteoporosis screening and management programs.
Background There are limited data on cardiovascular complications of coronavirus disease 2019 in pregnancy, and there are only a few case reports on coronavirus disease 2019 related cardiomyopathy in pregnancy. Differentiation between postpartum cardiomyopathy and coronavirus disease 2019 related cardiomyopathy in pregnant women who develop severe acute respiratory syndrome coronavirus-2 infection during peripartum could be challenging. Here, we present a case of possible coronavirus disease 2019 related cardiomyopathy in a pregnant patient, followed by a discussion of potential differential diagnosis. Case presentation In this case report, we present the case of a young pregnant Iranian woman who developed heart failure with pulmonary edema after cesarean section. She was treated because of low left ventricular ejection fraction and impression of postpartum cardiomyopathy, and her severe dyspnea improved by intravenous furosemide. On day 3, she exhibited no orthopnea or leg edema, but she was complaining of severe and dry cough. Further evaluation showed severe acute respiratory syndrome coronavirus-2 infection. Conclusions The possibility of severe acute respiratory syndrome coronavirus-2 infection should be considered in any pregnant woman who develops cardiomyopathy and pulmonary edema.
Objective: Helicobacter pylori infects at least 50% of the world’s human population. The current study aimed to assess and compare the efficacy of triple versus quadruple therapy. Methods: Randomized clinical trials (RCTs) consisting of triple and quadruple therapy were identified through electronic and manual searches in the national and international online databases (IsI, Magiran, Embase, PubMed, and Scopus). The random-effects model was applied to pool analysis. Funnel plots and the Egger test were used to examine publication bias. Results: After a detailed review of the selected articles, 79 RCTs were included in the meta-analysis; it was based on using triple and quadruple therapy as the first and second-line treatment. The results showed that quadruple therapy in the first-line treatment had a higher eradication rate than triple therapy. Overall, the eradication rate with triple therapy was 74% (95% CI, 71%-77%) for intention-to-treat (ITT) analysis and 80% (95% CI, 77%-82%) for per-protocol (PP) analysis. Generally, the eradication rate with quadruple therapy was 82% (95% CI, 78.0%-86.0%) for ITT analysis and 85% (95% CI, 82.0%-89.0%) for PP analysis. The analysis also revealed that quadruple therapy was more effective for 7 or 10 days. Conclusion: The current study results demonstrated that quadruple therapy has better effectiveness than triple therapy as the first-line treatment; however, in the second-line treatment, the effectiveness of quadruple and triple regimens is almost similar. The effectiveness of quadruple therapy in the Asian population was found to be slightly higher than that of triple therapy, while this difference was considerably higher in the European population.
Introduction Acinetobacter baumannii is an opportunistic pathogen that can cause hospital-acquired infections. Indiscriminate use of antibiotics has led to a significant increase in the incidence of acquired drug resistance among clinical isolates of A. baumannii. This study aims to assess the resistance to carbapenems between A. baumannii clinical isolates using a meta-analysis study. Methods The databases of Scopus, PubMed, Google Scholar, Web of Science, and Iranian national databases (SID, Magiran, and IranMedex) were searched until 2020. Studies were analyzed based on the random-effects model. Heterogeneity between studies was evaluated by calculating the I 2 index. Statistical analysis was performed using STATA (version 14.2; StataCorp, College Station, Tex). Results Finally, 46 articles were found to meet the criteria, with a total sample size of 62,779 cases. Resistance to imipenem and meropenem was detected in 62% and 64% of cases, respectively. The sensitivity of A. baumannii clinical isolates to imipenem and meropenem was obtained at 34% and 37%, respectively. In addition, the highest resistance to imipenem and meropenem was estimated in Asia (67% and 70%, respectively). However, the lowest resistance to imipenem and meropenem was estimated in Europe (50% and 57%, respectively). Conclusion The carbapenem resistance of A. baumannii is a global health problem that affects public health in the community. Based on our results, because of the high resistance of A. baumannii to carbapenems, the extensive use of carbapenems is less recommended.
Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is an established minimally invasive diagnostic tool for the evaluation of mediastinal and hilar lymphadenopathy. There is a paucity of data on its complications that usually include self-limiting bleeding, infections, and rarely pneumothorax/pneumomediastinum. CASE PRESENTATION: A 71-year-old male with a past medical history of cirrhosis, COPD with 45 pack-year smoking history, chronic hypoxic respiratory failure on 2 L/min home oxygen, OSA on BiPAP, was evaluated in pulmonary clinic for mediastinal and right hilar adenopathy. He underwent bronchoscopy with EBUS guided 21-gauge TBNA of station 7 lymph node. A chest xray post bronchoscopy was unremarkable. The patient was discharged with outpatient follow-up. He presented two days later with bilateral chest pain. A chest x-ray showed bilateral pleural effusions, and CTchest showed a 6.5 x 4.6 cm mass with partial cavitation in the subcarinal region of the mediastinum with intrinsic soft tissue gas. The patient was intubated due to worsening hypoxemic hypercapnic respiratory failure and started on broad-spectrum antibiotics. Repeat bronchoscopy did not show any bronco-mediastinal fistula but the narrowing of right lower lobe (RLL) medial segment with endobronchial tumor invasion. Endobronchial biopsies were obtained. EGD did not show esophago-mediastinal fistula. Hospital course was complicated by Strep mitis/oralis and Strep salivarius bacteremia followed by endocarditis. The pathology from both bronchoscopies was consistent with high-grade large B-cell lymphoma eroding into RLL parenchyma.
A twenty-two-year-old woman with a history of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) on rituximab presented with fever, abdominal pain, and worsening shortness of breath requiring supplemental oxygen via nasal cannula one month after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection from which she was minimally symptomatic and had recovered. Radiographic studies revealed bilateral patchy consolidations interspersed with ground-glass opacities (GGO). She was started on antibiotics for presumed community-acquired pneumonia with no improvement. Echocardiography revealed preserved biventricular function and a suspected intracardiac mass. A cardiac magnetic resonance imaging (CMRI) revealed myocarditis and no intracardiac mass. Fever persisted and oxygen requirements increased from FiO2 0.4 to 1.0. Repeat CXR showed subtotal left hemithorax opacification. Bronchoscopic samples showed a negative Gram stain and an unremarkable cell count differential. In view of this and given her lack of response to antibiotics with worsening respiratory status, high-dose steroids were started. She improved rapidly, and six days later she was off oxygen. Transbronchial biopsies showed benign parenchyma with some intra-alveolar fibrin deposition with no definitive evidence of viral cytopathic effect, vasculitis, or diffuse alveolar damage (DAD). Follow-up imaging in the pulmonary clinic revealed improvement of prior airspace disease with some new migratory opacities that completely resolved after 12 weeks. Pulmonary function tests and repeat CMRI were normal three months after discharge. Multisystem inflammatory syndrome in adults (MISA), postcovid organizing pneumonia (OP), and immune reconstitution inflammatory syndrome (IRIS) are rare and potentially steroid-responsive causes of pneumonia, which were in our differential diagnosis. It is imperative to consider the rare possibility of steroid-responsive pneumonia-like MISA, post-COVID-OP, and IRIS in patients with worsening respiratory symptoms following a recent SARS-CoV 2 infection.
INTRODUCTION:Neurofibromatosis type I (NF-1) is a rare disorder that affects multiple organs, with cutaneous findings being the most well-known. It is an autosomal dominant disease caused by dysplasia of ectoderm and mesoderm with variable expression [1]. NF is characterized by a collection of neurofibromas, café au lait spots, and Lisch nodules. Neurofibromatosis is a rare disease and only 10-20% of the cases have associated diffuse lung disease (NF-DLD). Thus, many of the specific characteristics have yet to be elucidated [2].CASE PRESENTATION: A 50-year-old white man with NF-1 diagnosed by skin biopsy 2 years ago was seen by his PCP due to worsening shortness of breath associated with a productive cough. Levofloxacin was ordered, but 5 days later symptoms persisted so he was referred to the ED.He reported a prior tube thoracostomy after spontaneous right-sided pneumothorax.Family history was remarkable for neurofibromatosis in his mother and spontaneous pneumothorax in his brother. However, his brother does not have any of the cutaneous findings consistent with NF.He is a former smoker with a 20 pack-year history, quitting a month before admission. He works in a furniture company with exposure to wood dust and chemical fumes for more than 30 years.He denies any fever, chills, chest pain, or weight change. Denies any sick contacts.Physical examination demonstrated no respiratory distress. He had mild bibasilar crackles and multiple neurofibromas throughout his body, more so on his back. SARS-CoV-2, influenza A, influenza B, RSV PCR were all negative. Chest x-ray demonstrated peripheral interstitial opacities. He was started on empiric antibiotic coverage for community-acquired pneumonia. Chest CT showed evidence of upper lobe predominant cystic disease and pulmonary reticular abnormalities in the lower lobes consistent with neurofibromatosis associated diffuse lung disease. Centrilobular emphysema and mild bronchiectatic changes were also noted. He was started on bronchodilators with a 5day course of prednisone. Respiratory status returned to baseline and he was discharged with a LABAþLAMA inhaler and followup with the pulmonary clinic. DISCUSSION:The exact prevalence of NF-DLD is unknown. Based on the limited case reports, NF-DLD is more predominant in men, occurring during the third or fourth decade of life with dyspnea being the more common presenting symptom. Whether smoking plays a role in NF-DLD is still unknown. The typical HRCT finding in NF-DLD is upper-lobe cystic and bullous disease with basilar interstitial lung disease. HRCT results demonstrate bibasilar reticular opacities 50%, bullae 50%, ground-glass opacities 37%, cysts, and emphysema 25% [3].CONCLUSIONS: NF-DLD is considered one of the rare etiologies of cystic lung disease characterized by upper lobe cystic and bullous disease and lower lobe interstitial changes.
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