علیرضا فیروزجاهی

People who are infected with Human Immunodeficiency Viruses (HIV) are more prone to opportunistic fungal infections than other patients. The immune system of these patients becomes weaker when they are also infected with Coronavirus disease (COVID-19). Involvement of the central nervous system caused by fungal infections in these patients is of concern and fatal if diagnosed late. The aim of this research is to investigate a woman with COVID-19 and HIV who was diagnosed with cryptococcal meningitis.

Case Report:

 The patient is a 53-year-old woman who complained of severe headache and nausea after infection with COVID-19. White blood cells, erythrocyte sedimentation rate, lymphocyte, creatinine, aspartate aminotransferase, alanine aminotransferase and blood urea nitrogen were increased compared to the standard level. Cerebrospinal fluid testing showed that glucose was lower and protein was higher than normal. Microscopic examination, staining and culture of cerebrospinal fluid deposits showed the presence of double wall yeasts similar to Cryptococcus. The patient was positive for COVID-19 and HIV. The level of CD4 (cluster of differentiation 4) was lower than the standard. The patient was treated with amphotericin B at a dose of 100 mg for two weeks and was discharged from the hospital after the conditions were stabilized.

Cryptococcal meningitis can often occur in immunosuppressive conditions such as HIV. Therefore, quick follow-up, diagnosis and treatment should be considered in these patients.

Infection with Strongyloides stercoralis is common in tropical and subtropical regions. To prevent and treat these diseases, information on the distribution and frequency of these parasites in different geographical areas is needed. Due to the importance of diseases in the northern provinces of Iran, the present study was performed to determine the prevalence of Strongyloides stercoralis.

From April 2011 to March 2020, stool samples from patients who were referred to Rouhani hospital in Mazandaran province, Babol, were gathered. For stool samples, microscopic detection was performed immediately using the wet expansion method, followed by a formal-ether concentration process. Based on the sample size calculation, the minimum number of patients with Strongyloides stercoralis infection was considered to be 380 patients from the years 2011-2020. Mean and standard deviation indices were used to describe quantitative data and numbers and percentages were used to describe qualitative data.

Out of the total number of 39,800 archived patient files that were reviewed, a total of 420 (1.05%) patients were confirmed for the presence of Strongyloides stercoralis in their feces. The age range of patients was 3 to 89 years. The population of male patients (249 patients) was higher than females (171 patients). In patients with positive Strongyloides stercoralis, disease symptoms were positive in 206 patients and negative in 214 patients. The most common underlying disease in patients was abdominal pain (220 patients). 271 patients received steroids.

Strongyloides stercoralis infection was detected in the northern region of Iran. The prevalence of this parasite was higher in men, the elderly, and people with underlying comorbidities. These results can be used to identify and compare areas where the prevalence of infection is higher. Therefore, revealing the effect of Strongyloides stercoralis infection on public health makes the need for in-depth clinical and diagnostic studies important. People with chronic diseases, whether symptomatic or asymptomatic, should be screened for parasitic diseases.

Neonatal jaundice is a major problem among infants in the first weeks of life. Research on several indicators of severe neonatal jaundice including alpha-fetoprotein and umbilical cord bilirubin level has indicated contradictory results. Therefore, the aim of the present study was to evaluate the significance of umbilical cord bilirubin level as a predictive indicator of severe neonatal jaundice.

This prospective, cross-sectional study was performed on 102 healthy infants, born to healthy mothers at Babol Clinic Hospital, Babol, Iran. After birth, 2 cc blood samples were obtained from the umbilical cord and the bilirubin level was measured in the hospital laboratory. The infants were followed-up after hospital discharge in terms of jaundice presentations. In case jaundice was diagnosed in infants, they were compared in treated and untreated groups.

Clinical jaundice was not detected in 54 cases (52.94%). Overall, 48 neonates (47.05%) suffered from clinical jaundice and 10 cases (8.9%) presented with severe jaundice, requiring treatment based on the criteria proposed by the American Academy of Pediatrics (AAP). The mean umbilical cord bilirubin level was 1.82±0.42 mg/dl in the untreated group and 2.36±0.56 mg/dl in the treated group (P=0.000). The area under the ROC curve for umbilical cord bilirubin level was 0.722 in the treated group, based on the AAP criteria. The cut-off point of 2 mg/dl showed 80% sensitivity and 73% specificity in predicting severe jaundice (requiring treatment), based on the AAP criteria.

As the results indicated, measurement of umbilical cord bilirubin level and determination of a suitable cut-off point could be valuable in predicting severe jaundice in newborns.

Given the importance of blood glucose regulation in prevention of diabetic complications and considering the fact that the patients tend to eat foods that reduce blood sugar، the main objective of this study was to determine the effect of apple cider vinegar on postprandial blood glucose in patients with type 2 diabetes.

In this clinical trial study، thirty type 2 diabetic patients randomly divided in two groups (each group 15 patients). In fasting condition case group received combine apple cider vinegar، 20 gr and 40 gr of water and control group received 40 gr water and immediately، both groups were given breakfast containing 58 grams of carbohydrate. The cross-over trial was conducted after 1 week wash out. Blood samples were collected at fasting and 90 min post breakfast for glucose and insulin analysis. (IRCT: 201201078630N1)

Mean (±SE) changes in blood glucose while using apple cider vinegar versus placebo respectively was 118. 7±10. 31mg/dl، 106. 9±10. 37mg/dl. Mean (±SE) changes of insulin level when using vinegar was 23. 1±3. 69? u/ml versus17. 3±3. 39? u/ml when using placebo. There were no significant differences between two groups.

Although results of this study showed that apple cider vinegar has no effects on postprandial plasma glucose and insulin.

Rheumatoid Arthritis, (RA) is a chronic inflammatory autoimmune disease with a progressive course requiring early diagnosis and treatment. The value of anti-cyclic citrullinated peptide antibodies (Anti-CCP) in the diagnosis of RA has been shown in several studies. The present study was designed to determine and compare the diagnostic value of Anti-CCP and rheumatoid factor (RF) for RA.

207 females and 48 males with RA, diagnosed by clinical criteria, with the mean age of 50±13.8 years and 290 non-RA controls with the mean age of 47±14 years were enrolled in the study. Serum samples were taken for assessment of Anti-CCP and RF from all participants. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio(LR+), and negative likelihood ratio (LR-)and their 95% confidence interval (95%CI) were estimated by comparison of patients with controls.

In patients with RA, Anti-CCP was positive in 79.2% and RF was positive in 72.1% and both antibodies were positive in 64.7%, and both negative in 13.3%. 47.8% of seronegative RA were Anti-CCP positive and 7.8% of anti-CCP negative were RF positive.. Sensitivity, specificity, PPV, NPV, LR+ and LR- for Anti-CCP in diagnosis of RA were: 79.2%, 94.8%. 93.08%, 83.8%, 13.46 and 0.19 respectively for RF the respective values were 72.1%, 90.6%, 87.2 %, 78.7%, 6.81, and 0.26. For both Anti-CCP and RF the values were 64.7%, 97.5%, 95.9 %, 75.8%, 26.8and 0.36. Anti-CCP was more diagnostic than RF and both antibodies had more diagnostic values than either of them alone. Anti-CCP yielded a specificity of 89.6% and PPV of 85% for diagnosis of seronegative RA.

The findings of this study indicate that anti-CCP has a higher diagnostic performance than RF. It is highly useful in the diagnosis of seronegative RA. In addition, presence of both antibodies is more diagnostic than either of them alone.

Lyme disease is caused by the spirochete Borrelia burgdorferi. Depending on the stage of illness, infection may be limited to the skin or involve the cardiac, nervous and musculoskeletal systems. Herein, we report a case of Lyme disease in a 23-year-old woman from North of Iran (Mazandaran) in early-localized stage of erythema chronicum migrans. The diagnosis was confirmed by the presence of serum antibody using ELISA method.

Cancer is the second most common cause of death in developed countries. The incidence of the different histological types of cancer varies greatly between different populations and it is attributed to occupational, social, cultural, racial, (possibly hereditary), and geographic influences. The objective of this study was to determine the pattern of age distribution and the frequency of different cancers, registered in different diagnostic centers in Babol during the year 2001.

In a cross–sectional study, characteristics of all registered malignancies were obtained from special records in different diagnostic centers in Babol using the International Classification of Disease (ICD). The data were analyzed using SPSS software.

Among 632 cases, 57.9% were males and 42.1% were females. 53.3% of malignancies occurred after 60 years old and 46.7% before 60 years. The mean age at diagnosis was significantly higher among males (59 years) than females (51 years), (p<0.001). The 10 most common malignancies among males were: stomach (24.9%), skin (10.7%), esophagus (10.1%), urinary bladder (8.2%), prostate (6.6%), colon and rectum (6.6%), hematopoietic system (4.9%), lymphatic system (4.6%), testes (3.8%) and connective tissue (2.7%). Meanwhile, the 10 most common malignancies among females were: breast (21.4%), stomach (12.4%), esophagus (12%), colon and rectum (9%), hematopoietic system (7.9%), skin (7.5%), lymphatic system (3.8%), cervix (3%), ovary (2.6%) and thyroid gland (1.5%).

With increasing age, the frequency of different cancers increases and our results indicate that more than half of the cases are 60 years or above. Stomach cancer is the most common malignancy of this region and occurs most frequently during 7th and 8th decades of life. The most common malignancy among females is breast cancer and occurs most frequently during the 4th-6th decades of life.