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X-linked agammaglobulinemia (XLA), characterized by a profound deficiency of B lymphocytes, is caused by mutations in the gene encoding Bruton tyrosine kinase (Btk).. XLA patients have a susceptibility to viral infections. In this report, we present a 45-year-old man with known XLA, with about a 2-week history of fever, chills, diarrhea and vomiting. He was diagnosed with COVID-19 infection, which was confirmed by a real-time reversetranscriptase- polymerase chain reaction. The antiviral drugs, antibiotics, and interferon-beta were administered to him. Unfortunately, the patient passed away after 5 days. During an epidemic of infectious diseases, the best strategy to overcome the potential challenges of treating XLA may be prevention. Early detection of biomarkers such as D-dimer and IL-6 might be more helpful for initiating more aggressive therapy and decreasing the duration of illness in these patients.

There is very little knowledge about the immune responses, particularly cellular immunity to coronavirus disease 2019 (COVID‐19). The main objective of this study was to evaluate the frequency of T helper (Th) cell subtypes, including Th1, Th17, and Treg cells, in moderate‐to‐severe and critical COVID‐19 patients compared to healthy controls. Twenty‐nine moderate‐to‐severe and 13 critical patients confirmed for COVID‐19, and 15 healthy subjects were included in this study. Interferon‐γ (IFN‐γ)‐producing Th1 and interleukin‐17A‐producing Th17 and Treg cells in peripheral blood were measured with flow cytometry. The frequency of Th1 and Th17 was significantly decreased in critical patients compared to healthy subjects (aMD: −2.76 and − 2.34) and moderate‐to‐severe patients (aMD: −1.89 and − 1.89), respectively (p

BACKGROUND: This study was aimed to investigate the risk factors for mortality in patients with COVID-19. METHODS: For this retrospective cohort study, we included 121 deceased and 436 discharged cases with COVID-19 in Babol, Northern Iran. The cases were between March 1 to April 1, 2020. RESULTS: Multivariate Poisson regression analysis revealed that older age (aRR: 1.03, 95% CI: 1.01, 1.05, p < 0.001), hospital length of stay (aRR: 0.94, 95% CI: 0.90, 0.97, p = 0.003), ICU admission (aRR: 4.34, 95% CI: 2.95, 6.37, p < 0.001), cerebrovascular disease (aRR: 1.96, 95% CI: 1.20, 3.19, p = 0.007), ventilator-associated pneumonia (VAP) (aRR: 2.09, 95% CI: 1.22, 3.55, p = 0.006), septic shock (aRR: 2.98, 95% CI: 1.44, 6.19, p = 0.003), acute respiratory distress syndrome (ARDS) (aRR: 3.80, 95% CI: 2.28, 6.31, p < 0.001), acute kidney failure (AKF) (aRR: 1.45, 95% CI: 1.12, 3.76, p = 0.021), acute heart failure (AHF) (aRR: 1.63, 95% CI: 1.01, 2.62, p = 0.043) and lymphocyte count (aRR: 3.01, 95% CI: 1.99, 4.57, p < 0.001) were associated with mortality. CONCLUSION: Findings showed that elderly with comorbidities such as cerebrovascular diseases had an increased risk of death. Some complications such as: pneumonia, septic shock, ARDS, AHF, and AKF played crucial roles as well death (Tab. 2, Ref. 25).

Miliary tuberculosis (TB) presents a major challenge following a renal transplant in humans. In the current report, we described a patient with disseminated TB following renal transplantation. The article presents the case of a 38-year-old man who presented an 8-month history of fever, chills, sweating, low-back pain and significant weight loss. Chest radiography and computed tomography (CT) scan showed miliary nodules distributed in the two lungs. The transbronchial lung biopsy revealed a granulomatous reaction with caseous necrosis. Magnetic resonance imaging (MRI) of the brain found multiple tuberculomas. Also, MRI of the lumbosacral was indicative of a psoas abscess. Therefore, miliary pulmonary, cerebral and spinal TB was confirmed. The patient was started on an anti-TB regimen and paravertebral aspiration was also done. The patient’s condition improved considerably. In conclusion, this case report can remind us of the importance of maintaining a high clinical suspicion and performing a thorough workup to establish a timely diagnosis and treatment of miliary TB.

Acute thromboembolic events have been frequently reported in patients with coronavirus disease 2019 (COVID-19) due to an increase in the coagulation system activity and endothelial dysfunction. This report describes a patient with COVID-19 who initially reported respiratory symptoms and developed acute lower limb ischemia secondary to extensive macrovascular arterial thrombosis, which was treated with thrombectomy. The development of such extensive arterial thrombosis with anticoagulants at therapeutic doses is a new sign of increased viral pathogenicity, and it is necessary to develop and apply updated prophylaxis protocols for thrombosis in these patients.

With the aim to analyze the clinical manifestations and outcomes of influenza, we evaluated the symptoms of proven H1N1 cases and outcomes of patients admitted to hospitals Babol University of Medical Sciences during 2015 - 2016. In this descriptive cross-sectional study, we included patients diagnosed with influenza-like illness (ILI) from October 2015 to March 2016 at hospitals affiliated to Babol University of Medical Sciences.To diagnose H1N1 infection, reverse transcription-polymerase chain reaction (RT-PCR) was performed on nasopharyngmeal swabs collected from the patients. In the current study, 123 patients were admitted due to ILI. The RT-PCR result was positive in 47.2% of patients. Symptoms such as productive cough (35.3%), sore throat (51.4%), headache (50%), dyspnea (53.2%) were comparable between PCR + H1N1 confirmed cases and H1N1 negative cases. Among the H1N1 confirmed cases, 48.3% were admitted to the intensive care unit (ICU) because of the disease severity, and 20.7% died even after receiving the therapy for several days. Among the infected cases, 20 women were pregnant, out of which three subjects died. Mortality was mostly observed in the age ˃ 50 (39%) (p = 0.03). Myalgia was significantly less observed in the group with mortality compared to other age groups (6.5% vs. 93.5%) (p = 0.005). The mortality rate of patients who received vancomycin was found to be significantly low (40%) (p = 0.01). In mortality group, the frequency of patients with creatinine levels > 1.5 mg/dL was significantly higher (58.3%) (p = 0.009) than in the group of patients who recovered. The average length of hospitalization in the mortality group was significantly longer than the hospitalization of the recovered group (11.1 days vs. 6.3 days) (p = 0.02). The current study reported a mortality rate that was more than expected in comparison to previous seasons. Our study results suggest that the absence of typical influenza symptoms such as myalgia should not cause a delay in the diagnosis of this infection in cold seasons.

There is a limited number of clinical studies on interferon (IFN) levels in human brucellosis. The novel group of interferons, type III interferons, consists of four IFN-λ (lambda) molecules called IFN-λ1 or Interleukin-29 (IL-29), IFN-λ2 or IL-28A, IFN-λ3 or IL-28B, and IFN-λ4, are not fully known. This study is one of the first studies of IL-28A and IL-29 levels in Brucellosis cases at the end of their treatment course. A total of 33 acute Brucellosis patients were included in this study. We considered changes in the levels of IL-28A and IL-29 in cases with acute brucellosis before and after treatment with standard therapy that referred to the Ayatollah Rohani Hospital in Babol, Northern Iran. Serum IL-29 and IL-28A (acute form: 56.4 ± 30.32 and 48.73 ± 27.72, respectively, and post-treatment: 40.15 ± 20.30 and 38.79 ± 22.66, respectively) levels were elevated significantly in acute brucellosis than after treatment (p ≤ 0.05). These findings indicate that considering biomarker levels in Brucellosis patients may be indicative of the chronicity of infection. In conclusion, we suggest that IL-29 and IL-28A levels may be valuable biomarkers for follow-up patients with brucellosis.

On December 31, 2019 novel Coronavirus (SARS-CoV-2) is the strain of Coronavirus that causes Coronavirus disease 2019 (COVID-19) It was initially reported from Wuhan, China This novel virus causes atypical clinical presentations that differs from other viral pneumonias;in fact, some clinical aspects of infection are not cleared today We present the case of a 69-year-old man with a 2-week history of dyspnea and hemoptysis He was diagnosed with COVID-19 infection, confirmed by real-time reverse-transcriptase-polymerase chain reaction On day 11 postadmission, the case's condition improved significantly, with his oxygen saturation rising and lymphopenia subsiding His dyspnea gradually decreased in severity;furthermore, hemoptysis was controlled after treatment This case indicates the complexity and variety of pneumonia complications caused by COVID-19 infection We must have a high clinical suspicion in management of suspected cases especially in patients with novel clinical presentations such as our case in a pandemic Thus, hemothorax due to viral lung parenchymal destruction can be a complication of COVID-19 pneumonia

There is a limited number of clinical studies on interferon (IFN) levels in human brucellosis. The novel group of interferons, type III interferons, which consists of four IFN-λ (lambda) molecules called IFN-λ1 or interleukin-29 (IL-29), IFN-λ2 or IL-28A, IFN-λ3 or IL-28B, and IFN-λ4, is not fully known. This study is one of the first studies of IL-28A and IL-29 levels in brucellosis cases at the end of their treatment course. A total of 33 acute brucellosis patients were included in this study. We considered changes in the levels of IL-28A and IL-29 in cases with acute brucellosis before and after treatment with standard therapy that referred to the Ayatollah Rohani Hospital in Babol, northern Iran. Of 33 included patients, 22 (66.6%) were males, and 11 (33.4%) were females. The range of patients’ age was 49.21 ± 17.70 years. Serum IL-29 and IL-28A (acute form: 56.4 ± 30.32 pg/mL and 48.73 ± 27.72 pg/mL, respectively, and posttreatment: 40.15 ± 20.30 pg/mL and 38.79 ± 22.66 pg/mL, respectively) levels were elevated significantly in acute brucellosis than after treatment ( p < 0.05 ). These findings indicate that considering biomarker levels in brucellosis patients may indicate the chronicity of infection. In conclusion, we suggest that IL-29 and IL-28A levels may be valuable biomarkers for follow-up patients with brucellosis.

While some biomolecules have been explored to identify potential biomarkers for prognosis of the COVID-19 prognosis, there are no reliable prognostic indicators of disease progression and severity. We aimed to evaluate the ability of the C-reactive protein (CRP) to predict COVID-19 infection. This retrospective study was conducted on 429 patients diagnosed with COVID-19 between March 30, 2020, and April 30, 2020. The study population was divided into severe cases (n = 175) and nonsevere cases (n = 254). Data on demographic characteristics, clinical features, and laboratory findings on admission were collected. The proportion of patients with increased CRP levels was significantly higher in severe cases than in nonsevere patients. Analysis of ROC curve found that CRP could be used as an independent factor in predicting the severity of COVID-19 infection. Also, patients with CRP > 64.75 mg/L were more likely to have severe complications. The serum levels of CRP can predict the severity and progression of illness in patients with COVID-19.

Background Extracorporeal blood purification has been proposed as one of the therapeutic approaches in patients with coronavirus infection, because of its beneficial impact on elimination of inflammatory cytokines. Methods This controlled trial has been conducted on critically ill COVID-19 patients admitted in the state hospital affiliated to Babol University of Medical Sciences, Iran who received different antiviral and antibacterial drugs, and different modalities of respiratory treatments and did not have positive clinical improvement. No randomization and blindness was considered. All of the participants underwent three sessions of resin-directed hemoperfusion using continuous renal replacement therapy with a mode of continuous venovenous hemofiltration (CVVH). Results Five men and five women with a mean age of 57.30 ± 18.07 years have been enrolled in the study; and six of them have improved after the intervention. Peripheral capillary oxygen saturation (SpO2) changed after each session. Mean SpO2 before the three sessions of hemoperfusion was 89.60% ± 3.94% and increased to 92.13% ± 3.28% after them (p p = 0.073); and c-reactive protein decreased from 136.25 ± 84.39 to 78.25 ± 38.67 mg/L (P = 0.016). Conclusions Extracorporeal hemoadsorption could improve the general condition in most of recruited patients with severe coronavirus disease; however, large prospective multicenter trials in carefully selected patients are needed to definitely evaluate the efficacy of hemoperfusion in COVID-19 patients. Trial registration The research protocol has been registered in the website of Iranian Registry of Clinical Trials with the reference number IRCT20150704023055N2.

Background. In December 2019, China has experienced an outbreak of novel coronavirus disease 2019 (COVID-19). Coronavirus has now spread to all of the continents. We aimed to consider clinical characteristics, laboratory data of COVID-19 that provided more information for the research of this novel virus. Methods. We performed a retrospective cohort study on the clinical symptoms and laboratory findings of a series of the 100 confirmed patients with COVID-19. These patients were admitted to the hospitals affiliated to Babol University of Medical Sciences (Ayatollah Rohani, Shahid Beheshti and Yahyanejad hospitals) form 25 February 2020 to 12 March 2020. Results. Nineteen patients died during hospitalization and 81 were discharged. Non-survivor patients had a significantly higher C-reactive protein (CRP) (MD: 46.37, 95% CI: 20.84, 71.90; P = 0.001), white blood cells (WBCs) (MD: 3.10, 95% CI: 1.53, 4.67; P < 0.001) and lower lymphocyte (MD: –8.75, 95% CI: –12.62, –4.87; P < 0.001) compared to survivor patients Data analysis showed that comorbid conditions (aRR: 2.99, 95% CI: 1.09, 8.21, P = 0.034), higher CRP levels (aRR: 1.02, 95% CI: 1.01, 1.03, P = 0.044), and lower lymphocyte (aRR: 0.82, 95% CI: 0.73, 0.93, P = 0.003) were associated with increased risk of death. Conclusions. Based on our findings, most non-survivors are elderly with comorbidities. Lymphopenia and increased levels of WBCs along with elevated CRP were associated with increased risk of death. Therefore, it is best to be regularly assessed these markers during treatment of COVID-19 patients.

Sarcoidosis is a granulomatous condition with unidentified etiology. This disease should be considered in differential diagnosis if non-caseating granulomas is noted in biopsies, because numerous cases presented with no clinical symptoms. Although the lung is the most common organ involved in the disease, there also is an extra-pulmonary form (

Rationale: Strongyloides stercoralis (S. stercoralis) is an intestinal nematode with a complicated life cycle that can involve the gastrointestinal system. Infected patients are generally asymptomatic; but if symptomatic, the symptoms will include skin rash, respiratory and gastrointestinal symptoms like abdominal pain, diarrhea, nausea and vomiting. Patient concerns: A 77-year old man presented with edema of the lower extremities and insignificant tenderness in the epigastric region. Diagnosis: The histopathology of gastric tissue showed severe inflammation and multiple ulcers in the cardia, antrum and proximal duodenum. A large number of rhabditiform larvae of S. stercoralis along with tissue hyperemia and infiltration of lymphoplasma cells, eosinophils, and neutrophils were found. Intervention: Treatment with albendazole. Outcome: Despite the albendazole treatment, the patient’s condition deteriorated and eventually died because of a sepsis-like syndrome. Lesson: Physicians should remain alert to the urgency due to threadworm, especially among the elderly people and immunosuppressed cases; and should ensure accurate diagnosis, suitable treatment and careful follow-up of these cases.

Objective: To investigate antibiotic resistance pattern of ventilator-associated pneumonia (VAP) generating microorganisms, and quantitative culture and determining antibiotic sensitivity. Methods: This cross sectional study was performed on 50 patients suffering from VAP in intensive care unit of Ayatollah Rouhani Hospital, Babol, Iran during 2014–2015. VAP was probable for them based on clinical signs and the criteria of Clinical Pulmonary Infection Score standards. Lower respiratory samples were given under bronchoalveolar lavage and quantitative culture was done on them. Afterwards by microdilution method, minimal inhibitory concentration based on respective microorganisms, considering clinical pulmonary infection score were determined. Results: From 50 investigated samples in this study, the most common microorganisms were Acinetobacter baumannii (A. baumannii) (70%) then Pseudomonas aeruginosa (12%), Staphylococcus aureus (8%) and Klebsiella pneumonia (3%). In our study A. baumannii showed approximate 100% resistance to all antibiotics, in a way that A. baumannii resistance to imipenem and meropenem and piperacillin/tazobactam each was 97.1%. The most resistance of Pseudomonas aeruginosa was 66.7% to each cefepime and ceftazidime and clavulanate/ticarcillin. Staphylococcus aureus showed 75% resistance to nafcillin, cloxacillin and resistance in case of vancomycin was not seen. Conclusion: In current study, A. baumannii had the most prevalence among VAP and this species is resistant to most of antibiotics. Using ceftazidime, cefepime and clavulanate/ticarcillin, in treatment of the patients suffering VAP is not reasonable.

Leptospirosis is a common disease between humans and animals. Identifying common serogroups and comparing different clinical symptoms among them can help in finding the clinical pattern associated with pathogen serogroupes of leptospirosis. Therefore, the purpose of this study has been to investigate the common serotypes of the infection and their clinical symptoms in northern Iran. This cross-sectional study was carried out in educational hospitals of Babol University of Medical Sciences during the years 2011- 2014. Subjects with clinical findings consistent with leptospirosis were included in the study. According to the standard MAT guidelines, the titre >=1: 200 was considered positive. Then, the patients identified by serogroup separation, were examined and compared clinical symptoms. Among 6o patients with primary diagnosis of leptospirosis in this study, 35 of them proved to be infected to the disease. The most common serogroups were serjoe (40%) and icterohemorrhagia (31.4%). Autumnalis (22.8%), grippotyphosa (11.4%), canicola (8.6%), and pomona (2.8%) were included the subsequent serogroups. The highest frequency of fever (28%) and gastrointestinal manifestations (36%) were observed in icterohemorrhagia and the highest icterus (30%) was found in serjoe serogroup. In this study, serjoe serogroup with fever and icterus, and then icterohemorrhagia with fever and gastrointestinal symptoms were introduced as the most common serogroups of Leptospirosis. Also the rarest serogroups were canicola and pomona.