Reviews in Clinical Medicine
Volume:10 Issue: 1, Winter 2023

Coronavirus disease 2019 (COVID-19) is one of the most significant medical problems of the century. Mucormycosis infection is one of the devasting problems associated with this disease. Brain abscess associated with these conditions may have very poor prognosis, and prompt diagnosis as well as treatment of it is of paramount importance. In this study, we introduce a diabetic middle-aged man  who was treated with corticosteroids due to COVID-19, and affected by rhinocerebral mucormycosis. Due to eye chemosis, brain MRI was performed  which showed a silent abscess in temporal lobe with no neurological symptoms. After ten weeks of treatment, serial endoscopic sinus surgery and antifungal therapy, the invasive fungal sinusitis and brain abscess healed without debilitating sequala. We introduced this case as an educational example of brain involvement in mucormycosis. Although very rare,  due to possible fatal sequalae, brain abscess should be considered as a probable complication of mucormycosis even if the patient has no neurological symptom.

Various studies have assessed the link between the thyroid and kidney and concluded that dysfunction in one organ can disrupt the other. Thyroid dysfunction is more prevalent in individuals with end-stage renal disease (ESRD) compared to the general population. Hypothyroid ESRD patients have higher mortality than euthyroid patients. In this study, we evaluated the prevalence of hypothyroidism in dialysis-dependent ESRD patients and assessed the association of possible prognostic factors with mortality.

Patients who were undergoing dialysis in centers affiliated with the Mashhad University of Medical Sciences were enrolled and followed for a year to obtain survival rates. Lab parameters including thyroid stimulating hormone (TSH), parathyroid hormone (PTH), and magnesium (Mg) were recorded at baseline, and the relationship between these values and mortality was assessed.

The prevalence of hypothyroidism was 23% and 32.5% in hemodialysis and peritoneal dialysis patients, respectively. Blood urea was meaningfully higher in hemodialysis patients, while hypocalcemia and hyponatremia were more common in peritoneal dialysis patients. Higher ages (P=0.006), lower baseline Mg (P=0.044) and PTH (P=0.01), and diabetes (P=0.037) were all linked to a higher risk of mortality.

Hypothyroidism was notably prevalent in our study population. As hypothyroidism is associated with higher mortality, proper screening and intervention in this group are essential. We recommend the prescription of supplementary Mg in dialysis patients as baseline Mg and PTH levels are associated with better outcomes in this group. Diabetes was also associated with higher mortality. Maintaining glycated hemoglobin between 6%-8% is therefore suggested to increase the survival of diabetic patients.

Gestational diabetes is a multifactorial disease that genetic and environmental factors affect insulin sensitivity. This study was designed with consideration towards the importance of micronutrients in carbohydrate metabolism. The present case-control study was performed on 100 pregnant women referred to Imam Reza Hospital in Mashhad, Iran. Fifty pregnant women with gestational diabetes as defined by the American Diabetes Association guideline were considered as the case group and 50 non-diabetic pregnant women formed the control group. Maternal demographic information was recorded in the checklist . Serum levels of zinc, copper, selenium and chromium were measured in both groups. After data collection, they were processed with spss16 software.The mean age of diabetic and non-diabetic pregnant mothers was 32.33 ± 5.92 and 26.32 ± 5.38 years respectively, and their mean weight was 82.87 ± 10.81 kg in the case and 73.18 ± 10.6 kg in the control group. Maternal weight and age in the gestational diabetes group were significantly higher. (both p < 0.05). There was a significant difference between the case and control groups in terms of family history of diabetes in first-degree relatives; history of formula fed mothers during infancy, gravid > 3 ,and low gestational age were all more common in women with gestational diabetes (p < 0.05). In contrast to chromium, serum levels of zinc, copper and selenium were higher in the group with gestational diabetes. No significant relation was observed between serum zinc, copper, chromium and selenium levels with gestational diabetes.

Spinal anesthesia is gaining popularity and more frequent use due to its efficacy, patient satisfaction, lower complication rates, and good durability. Nerve blocks reduce the complications and risks associated with general anesthesia and lessen the patient’s need for postoperative care compared to general anesthesia, leading to earlier patient discharge. One spinal procedure involves administering low doses for anesthesia induction. This review article explored this approach by incorporating studies reporting the administration of lower doses of the local anesthetic bupivacaine. Findings indicate that lower and conventional doses of bupivacaine have comparable sensory and motor block impacts and induction times. However, the recovery time at lower doses is faster, and patients are discharged sooner from the postanaesthetic care unit. Complications associated with spinal anesthesia are significantly decreased at lower doses of bupivacaine administration. Thus, lower doses can be used to induce spinal anesthesia successfully with minimal adverse effects.

According to the World Health Organization (2022), severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is liable for more than 572 million cases worldwide and more than six million deaths globally. It has been reported that pregnancy can change the disease manifestations such that gastrointestinal symptoms, which are common in pregnant women, are difficult to distinguish from COVID-19 related complications. Hence, in isolated cases of gastrointestinal or liver forms of COVID-19, diagnosis might be delayed. Previous studies have suggested that serious complications of COVID-19 in pregnancy are associated with a higher body mass index (BMI), gestational diabetes, and older age; thus, this population should be considered as high risk. In this article, we summarized previously published evidence about pregnant women with COVID‐19 and liver dysfunction.

Asthma is a very common chronic disease among children. As for its treatment, in recent years there is an increased tendency towards supplemental treatments. Hence, many of these patients are administered complementary and alternative treatments including herbal medicine.Through a cross-sectional study, we evaluated the common herbal remedies used in asthmatic children referred to the allergy clinic of Sarvar Children’s Hospital in Mashhad. All data related to the patients (i.e., age, sex, and history of all remedies consumed as well as the responsible persons prescribing the pertinent medications) were recorded in a checklist. In this study, 582 asthmatic children with the average age of 77.4±41.7 months were evaluated. The overall herbal remedies usage was 59.8%. There was no significant differences between age groups, sex, or asthma severity and herbal remedy usage. Thirty-seven different herbal remedies were prescribed to the patients, the most common herb was thymes (65.3%) followed by a four-seed herbal mixture (23.6%), Plantago major (12%) and Cydonia oblonga (quince) (10.8%).Limited information is available regarding complementary and alternative medicine in asthmatic children in Iran. The present study showed the high prevalence of herbal medicine usage in asthmatic children in this region. Hence, further studies should determine the clinical benefits of these remedies

Currently, humankind is facing a COVID-19 pandemic that has spread worldwide. This is the first study conducted during the first phase of the COVID-19 outbreak in Mashhad, Iran, to describe the clinical, therapeutic, and laboratory findings of survivor and non-survivor patients with COVID-19. This retrospective study included a total of 191 confirmed COVID-19 patients aged ≥18 who were admitted to an intensive care unit in the northeast of Iran in 2020. Clinical, therapeutic, and laboratory findings were recruited. The data were analyzed using SPSS software (version 23) through the Mann-Whitney U test, Chi-Square test, independent sample t-test, as well as a single variable and multivariable logistic regression. Out of a total of 191 hospitalized patients, 137 (71.7%) survived and 54 (28.2%) expired. The mean age of non-survived patients was 17 years higher than that of survived patients (P<0.0001). Hypertension, diabetes, and coronary and pulmonary diseases were significantly related to mortality (OR: 3, 2.8, 21.4, and 5.4, respectively; P<0.05). Respiratory rate >24/min, heart rate>125/min, platelet count <100*109/L, creatinine >133 μmol/L, LDH >245 U/L, WBC count >10*109/L, lymphocyte count <0.8*109/L and D-dimer >1 μg/mL were frequently observed in non-survivor patients (P<0.05). Most of the patients had an abnormality on chest radiographs, and bilateral pulmonary infiltration was the dominant chest radiograph abnormality in these patients. Moreover, consolidation and ground-glass opacification were observed more frequently in non-survived patients (P<0.05). More than 57% of severe cases required non-invasive and invasive mechanical ventilation before they died, while it was 1% in survived cases (P<0.05). Older age, previous comorbidities such as diabetes, hypertension, coronary and pulmonary diseases, lymphopenia, leukocytosis, increased respiratory rate, creatinine, LDH, and D-dimer levels were related to a poor prognosis and mortality in patients with SARS-CoV-2 infection.

Multisystem inflammatory syndrome in children (MIS-C) is a novel syndrome in children following the coronavirus disease 2019 (COVID-19) pandemic, which has similar symptoms to Kawasaki disease or toxic shock syndrome. The most prevalent symptoms in MIS-C patients are fever and gastrointestinal symptoms, with substantial cardiac complications. Cardiac involvement is frequently reported in MIS-C patients and includes arrhythmia, coronary artery aneurysm and dilation, conduction abnormalities, and ventricular dysfunction. Cardiogenic or vasodilatory shock may develop in patients with severe MIS-C, necessitating inotropic support, fluid resuscitation, mechanical ventilation, and extracorporeal membrane oxygenation. Empirical therapies have attempted to reverse the inflammatory response, and steroids or intravenous immunoglobulin have all been commonly used. Most children will survive with prompt diagnosis and appropriate treatment, but since the disease's outcomes are unclear, long-term follow-ups are necessary. This narrative review summarizes the available studies regarding cardiac involvement in MIS-C cases as well as clinical considerations for cardiac examination and follow-up.