Topical anesthetics are commonly used over the counter, and one of the adverse effects of these medications is methemoglobinemia, which is a serious and life-threatening condition.
We describe a ...25-year-old Persian male presenting with generalized weakness, dizziness, headache, and cyanosis. In addition, he had genital warts starting 3 weeks ago, which were self-treated with podophyllin, resulting in itching and pain. He used over-the-counter topical anesthetics, including benzocaine and lidocaine, to reduce the symptoms. According to the lab data, signs and symptoms of methemoglobinemia and hemolysis were diagnosed. Considering the hemolysis, ascorbic acid was used for treatment. The patient was discharged after 5 days with normal arterial blood gas and pulse oximetry and no signs and symptoms.
This case highlights that self-administration of some topical anesthetics may lead to potentially fatal conditions.
Medical students should effectively manage conflicts in teamwork and communication with other team members. This study aimed to develop and validate a tool to evaluate attitude of medical students ...and physicians toward conflict management.
A multi-step process was employed to develop and validate a Conflict Management Attitude Questionnaire (CMAQ) based on the steps recommended in AMEE Guide No. 87. First, the initial items were obtained from the literature review and focus group. After cognitive interviews with the medical students and revision of the questionnaire, content validity was performed by experts. The construct validity and reliability of the questionnaire were assessed using exploratory Factor Analysis (EFA) and Cronbach's alpha coefficient, respectively.
This multi-step process resulted in a 12-item, five-point Likert-type questionnaire with satisfactory construct validity. Exploratory factor analysis revealed three factors, comprising the four items from the "perceived interactions in conflict management" subscale loading on the first factor, and five items from the "perceived value of learning conflict management" subscale loading on the second factor, along with three items from the "perceived application of conflict management" subscale loading on the third factor. All subscales described 56.48% of the variance. Validation results showed that Content Validity Index (CVI) and Content Validity Ratio (CVR) were greater than 0.75. Cronbach's alpha coefficient was 0.791.
This study showed that CMAQ has valid evidence for assessing the attitude of medical students toward conflict management with favorable psychometric properties and strong evidence of construct validity. However, due to the lack of evidence on any specific questionnaire to evaluate the attitude towards conflict management, future studies should conduct a confirmatory investigation regarding other aspects of medical students' attitudes toward conflict management.
Nowadays People use herbal medicines to try to maintain or improve their health but sometimes they cause side-effects and Some herbal drug may also interact with medication. We reported a 37 ...-year-old man who presented to the emergency department with sever watery diarrhea, vomiting, dysphagia, bicytopenia, renal failure and Acute esophageal necrosis, also known as black esophagus which is a rare syndrome characterized by a striking diffuse circumferential black appearance of the esophageal mucosa that universally affects the distal esophagus, 2-days after use of herbal drug named suranjan . Suranjan is a herbal formulation used to treat Rheumatoid arthritis
One of the critical factors with a broad impact on health is obesity. Besides its cardiovascular comorbidities, obesity’s probable association with hypogonadotropic hypogonadism inmen will be ...discussed in this article by reporting a severely obese boy, presenting with the absence of secondary sexual characteristics and hypertension. The hypothalamus-pituitary-gonadal axis can be influenced by several mechanisms at different levels of the axis. Some of these pathophysiological mechanisms, related to our case are explained to explore the association of obesity with reproductive disorders. Adipose tissue plays a prominent role in the metabolism of hormones that are secreted by other glands. Obesity as a preventable risk factor is valuable to be researched, to decrease the burden of its morbidity and mortality. Thus more studies should be done in the future to determine the complex network of factors contributing to hormonal imbalances seen in obese people.
In 2020, the SARS‐COV‐2 disease (COVID‐19) imposed huge challenges on the health, economic, and political systems, and by the end of the year, hope had been born with the release of COVID‐19 vaccines ...aimed at bringing the pandemic to an end. However, the COVID‐19 vaccination programs have sparked several concerns and ongoing debates over safety issues. Here, we presented three cases of patients with serious adverse events, encephalopathy, vaccine‐induced thrombotic thrombocytopenia, and leukocytoclastic vasculitis, after receiving the ChAdOx1 nCoV‐19 vaccine. Therefore, it is critical to investigate and report the occurrence of adverse reactions following vaccination, particularly serious ones, as it contributes to the growing body of research and assists clinicians in better diagnosing and managing them.
Despite the crucial role of COVID‐19 vaccination in controlling the pandemic, occurring of the severe adverse effects following inoculation is also inevitable and should be considered
Coronavirus disease 2019 (COVID-19) has become a significant clinical challenge in healthcare settings all over the world. Critically ill COVID-19 patients with acute respiratory distress syndrome ...may be at increased risk of co-infection with pulmonary aspergillosis. This study aimed to describe a clinical case of proven pulmonary aspergillosis caused by
in a 59-year-old man with a history of hospitalization due to COVID-19 infection.
The Covid-19 infection was confirmed by positive nasopharyngeal polymerase chain reaction. He had a cavitary lesion measured 20 mm in diameter with intracavitary soft tissue density in the left lung in the first chest computerized tomography scan. After 25 days, he showed two cavitary lesions in both lungs which raised suspicion of fungal infection; hence, the patient underwent a trans-thoracic biopsy of the cavitary lesion. The direct examination and culture of the biopsy material revealed
species. To confirm the
species identification, the beta-tubulin region was sequenced. The patient was treated with oral voriconazole.
This report underlined the importance of early diagnosis and management of invasive fungal infections in severe COVID-19 patients.
There are no determined treatment agents for severe COVID-19. It is suggested that methylprednisolone, as an immunosuppressive treatment, can reduce the inflammation of the respiratory system in ...COVID-19 patients.
We conducted a single-blind, randomised controlled clinical trial involving severe hospitalised patients with confirmed COVID-19 at the early pulmonary phase of the illness in Iran. The patients were randomly allocated in a 1:1 ratio by the block randomisation method to receive standard care with methylprednisolone pulse (intravenous injection, 250 mg·day
for 3 days) or standard care alone. The study end-point was the time of clinical improvement or death, whichever came first. Primary and safety analysis was done in the intention-to-treat (ITT) population.
68 eligible patients underwent randomisation (34 patients in each group) from April 20, 2020 to June 20, 2020. In the standard care group, six patients received corticosteroids by the attending physician before the treatment and were excluded from the overall analysis. The percentage of improved patients was higher in the methylprednisolone group than in the standard care group (94.1%
57.1%) and the mortality rate was significantly lower in the methylprednisolone group (5.9%
42.9%; p<0.001). We demonstrated that patients in the methylprednisolone group had a significantly increased survival time compared with patients in the standard care group (log-rank test: p<0.001; hazard ratio 0.293, 95% CI 0.154-0.556). Two patients (5.8%) in the methylprednisolone group and two patients (7.1%) in the standard care group showed severe adverse events between initiation of treatment and the end of the study.
Our results suggest that methylprednisolone pulse could be an efficient therapeutic agent for hospitalised severe COVID-19 patients at the pulmonary phase.
Background
Emergence of coronavirus disease 2019 (COVID‐19) is a major healthcare threat. Apparently, the novel coronavirus (SARS‐CoV‐2) is armed by special abilities to spread and dysregulate the ...immune mechanisms. The likelihood of oropharyngeal candidiasis (OPC) development in COVID‐19 patients with a list of attributable risk factors for oral infections has not yet been investigated.
Objectives
We here aim to investigate the prevalence, causative agents and antifungal susceptibility pattern of OPC in Iranian COVID‐19 patients.
Patients and Methods
A total of 53 hospitalised COVID‐19 patients with OPC were studied. Relevant clinical data were mined. Strain identification was performed by 21‐plex PCR and sequencing of the internal transcribed spacer region (ITS1‐5.8S‐ITS2). Antifungal susceptibility testing to fluconazole, itraconazole, voriconazole, amphotericin B, caspofungin, micafungin and anidulafungin was performed according to the CLSI broth dilution method.
Results
In 53 COVID‐19 patients with OPC, cardiovascular diseases (52.83%) and diabetes (37.7%) were the principal underlying conditions. The most common risk factor was lymphopaenia (71%). In total, 65 Candida isolates causing OPC were recovered. C albicans (70.7%) was the most common, followed by C glabrata (10.7%), C dubliniensis (9.2%), C parapsilosis sensu stricto (4.6%), C tropicalis (3%) and Pichia kudriavzevii (=C krusei, 1.5%). Majority of the Candida isolates were susceptible to all three classes of antifungal drugs.
Conclusion
Our data clarified some concerns regarding the occurrence of OPC in Iranian COVID‐19 patients. Further studies should be conducted to design an appropriate prophylaxis programme and improve management of OPC in critically ill COVID‐19 patients.
Abstract
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM
Objectives
Mucormycosis is a devastating infection caused by Mucorales order ubiquitously existing in the environment. Cerebral ...mucormycosis, the mortal manifested type of brain infection, is commonly seen in association with deep immunocompromised status. Despite lethality of brain mucormycosis, the lack of consensus data specifically concerning clinical manifestations, radiographical characteristics, diagnosis methods, and management are severely felt.
Methods
In this systematic review and meta-analysis, we searched PubMed and Scopus (up to December 31, 2018) using the combination of the following keywords: (‘Mucor*’ or ‘Zygomyc*’) and (‘cereb*’ or ‘brain’ or ‘central nervous system’ or ‘intracranial’) and found ∼1462 articles.
Only published case reports or case series with the definition of cerebral mucormycosis (finding the signs of this invasive mold in histopathological section or mycological examination and the presence of histopathological or radiological signs of brain involvement) were included. However, animal mucormycosis and papers in languages other than English or duplicates were excluded. Overall, 287/1462 articles were reviewed and included consisting of 345 cases of cerebral mucormycosis.
Results
A total of 206 (59.7%) patients were male. The most common risk factor was diabetes mellitus (51%), followed by hematological malignancies (23.8%). Remarkably, among hematological malignancies, acute lymphoblastic leukemia was significantly associated with cerebral mucormycosis (P <.001). In terms of reported risk factors, only 16.3% of patients had hematological malignancies till 2000, while the percentage of cases (29.7%) with this risk factor increased significantly after 2000 (P = .04). The most common clinical symptoms were orbital (46.4%) and neurological symptoms (41.2%), while headache was present in 35.9% of patients and fever only in 0.6%. Of the patients reported, 60.6% died and there was a significant correlation between mortality rate and diabetes mellitus (P = .003), while the mortality rate was not associated with other risk factors such as hematological malignancies.
Conclusions
In patients with mucormycosis, the presence of orbital clinical symptoms may suggest cerebral involvement as much as the presence of neurologic symptoms. Finally, it can be said that Cerebral Mucormycosis is a very fatal mold infection, especially if it occurs in diabetic patients.
Abstract
S1.1 Controversies in the clinical management of invasive candidiasis in critically ill patients, September 21, 2022, 11:00 AM - 12:30 PM
Objectives
With the emergence and spread of the ...coronavirus disease-19 (COVID-19) in the world, humans have been faced with the biggest challenge in health care systems in recent decades. The aim of the present study is to identify risk factors associated with oropharyngeal candidiasis (OPC) in COVID-19 patients.
Methods
The total number of confirmed COVID-19 patients was 218 (105 participants as cases who experienced OPC and 113 participants as controls without any evidence of OPC). The questionnaire used in this study consists of demography data, treatment strategy, clinical and laboratory data, and underlying diseases to collect information at the time of clinical OPC and follow them until the end of hospitalization.
Results
Pseudomembranous candidiasis (77/105, 73.3%) was the most prevalent form of OPC in case patients. The majority of cases (58.1%) and control (58.4%) groups were male. Increasing age of COVID-19 patients (P = .03) and length of hospitalization (P = .016) were significantly associated with OPC. Diabetes (P = .003), solid tumor (P = .019), and hypertension (P = .000) were the most common underlying conditions. Use of dentures (P = .003) and poor oral hygiene (P = .000) were related to OPC in case groups. Therapy with chloroquine (P = .012), IVIG (P = .001), diuretics (P = .000), and corticosteroid pulse therapy (P = .000) were significantly associated with the development of OPC in case patients.
Conclusion
It is reasonable to consider that old age, length of hospitalization, poor oral hygiene, corticosteroid usage, diabetes, solid tumor, and hypertension may predispose to the development of OPC in COVID-19 patients.
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