Molecular Detection and Clinical Characteristics of Bacterial and Viral Main Etiological Agents Causing Respiratory Tract Infections in Tehran, Iran (preprint)

Background: Respiratory tract infections are one of the most important infections among military personals, worldwide. The present study aimed to survey the prevalence of bacterial and viral main etiological agents causing respiratory tract infections among the military personnel in Iran. A cross-sectional study was performed from September 2020 to February 2021. Nasopharyngeal swabs were taken from patients, military personnel with respiratory tract infection symptoms. Detection of COVID-19 was performed with one step qRT-PCR method. TaqMan probe-based real-time PCR assay was used for the detection of influenza A and B viruses. The prevalence of adenovirus and M. pneumoniae were determined using nested PCR. Moreover, B. pertussis and S. pyogenes were identified by conventional PCR assay. The detection of H. influenzae was performed by multiplex PCR method. Results: Overall, 145 patients were included. Among viral pathogens, COVID-19, influenza A virus, and adenovirus were identified in 85.5%, 4.1%, and 1.4% of patients, respectively. Influenza B virus was not detected among military personnel. The frequency of bacteria etiological agents was as follows: S. pyogenes (2%), M. pneumoniae (0.7%), H. influenzae (0%), and B. pertussis (0%). Muscle aches (75.9%), headache (70.3%), lethargy (69%), cough (66.2%), stuffy nose (56.6%), fever (53.8%), and sore throat (53.1%) were amongst the most common clinical symptoms. Conclusions: Results showed that the military personals are the susceptible group to COVID-19 infection. Therefore, the accurate detection and implementation of control strategies such as vaccination are necessary.

Henoch–Schoenlein Purpura Following Severe Acute Respiratory Syndrome Coronavirus-2 Infection: A Case Report and Short Review of Histopathological Changes in Dermis (preprint)

As the novel Coronavirus pandemic continues to affect people worldwide, immune-mediated inflammatory syndromes have been reporting related to this virus. We presented a case of novel Coronavirus pneumonia, who developed a purpuric rash, abdominal pain, and hematuria, diagnosed with Henoch–Schoenlein purpura.

Sniffer Dogs as a Screening/Diagnostic Tool for COVID-19: A Proof of Concept Study (preprint)

Background: Sniffer dogs are able to detect certain chemical particles and are suggest to be capable of helping diagnose some medical conditions and complications, such as colorectal cancer, melanoma, bladder cancer, and even critical states such as hypoglycemia in diabetic patients. With the global spread of COVID-19 throughout the world and the need to have a real-time screening of the population, especially in crowded places, this study aimed to investigate the applicability of sniffer dogs to carry out such a task. Methods: : Firstly, three male and female dogs from German shepherd (Saray), German black (Kuzhi) and Labrador (Marco) breeds had been intensively trained throughout the classical conditioning method for seven weeks. They were introduced to human specimens obtained from the throat and pharyngeal secretions of participants who were already reported positive or negative for SARS-COV-2 infection be RT-PCR. Each dog underwent the conditioning process for almost 1000 times. In the meantime another similar condition process was conducted on clothes and masks of COVID-19 patient using another three male and female dogs from Labrador (Lexi), Border gypsy (Sami), and Golden retriever (Zhico) breeds. In verification test for the first three dogs, 80 pharyngeal secretion samples consisting of 26 positive and 54 negative samples from different medical centers who underwent RT-PCR test were in a single-blind method. In the second verification test for the other three dogs, masks and clothes of 50 RT-PCR positive and 70 RT-PCR negative cases from different medical center were used. Results: : In verification test using pharyngeal secretion, the sniffer dogs’ detection capability was associated with a 65% of sensitivity and 89% of specificity and they amanged to identify 17 out of the 26 positive and 48 out of the 54 true negative samples. In the next verification test using patients’ face masks and clothes, 43 out of the 50 positive samples were correctly identified by the dogs. Moreover, out of the 70 negative samples, 65 samples were correctly found to be negative. The sensitivity of this test was as high as 86% and its specificity was 92.9%. In addition, the positive and negative predictive values were 89.6% and 90.3%, respectively. Conclusion: Dogs are capable of being trained to identify COVID-19 cases by sniffing their odour, so they can be used as a reliable tool in limited screening.

Acute Transverse Myelitis After SARS-CoV-2 Infection: A Rare Complicated Case of Rapid Onset Paraplegia in a Male Veteran (preprint)

Background: SARS-CoV-2 (COVID-19) is a new human pathogen, and currently, the world has been plagued by its pandemic and there are no specific treatment options, mostly affects the respiratory system, ranging from mild flu-like symptoms to severe acute respiratory syndrome (SARS), but extra respiratory multi-systemic involvement has also been reported. Case presentation: A 63-yr-old Caucasian male veteran (retired army colonel), known case of controlled Type 2 diabetes, chronic renal failure and ischemic heart disease, about 4 days after the onset of flu-like syndrome (with no trauma history) experienced loss of control over both lower limbs, absent sensation from the chest below with constipation and urinary retention. Due to world SARS-CoV-2 (COVID-19) outbreak, his nasopharyngeal specimen was tested for COVID-19 reverse transcription polymerase chain reaction (RT-PCR) and positive result obtained. Chest x-ray and HRCT suggested severe pulmonary involvement. Immediately, he was admitted at emergency ward, treated based national COVID-19 protocol and a series of diagnostic procedures were started up to find out the cause of his non-heterogeneous peripheral (spinal) neuromuscular manifestations. Brain CT scan and MRI were normal, but spinal MRI with gadolinium contrast agent showing extensive increased T2 signal involves central grey matter and dorsal columns, extension between C7 and T12 with linear sagittally oriented enhancement posteriorly within the cord in the mid and lower thoracic cord. The CSF specimen obtained from LP shown pleocytosis, positive RT-PCR for SARS-CoV-2 and elevated IgG index. Clinical presentations, MRI, CSF and laboratory findings, after ruled out the other numerous possible causes with specific methods, suggested the Acute Transverse Myelitis (ATM) as a probably complication of COVID-19 infection. Intravenous methylprednisolone and then human immunoglobulin was added to treatment regimen. At the end, complete resolution of dysaesthesia, urinary retention and constipation were achieved. After continuous and long respiratory and motor rehabilitation programs, he was discharged home asymptomatic. Conclusions: : We believe that SARS-CoV-2 has a potential to produces different extra respiratory multi-systemic involvement as immune-mediated process and complexes, and this should be kept in mind whenever encounter a patient with acute onset of neurological manifestations, especially after microbial infections or vaccinations.

Evaluation of the Efficacy of Methylprednisolone Pulse Therapy in Treatment of Covid-19 Adult Patients with Severe Respiratory Failure: Randomized, Clinical Trial (preprint)

Background: Covid-19 is now global concern and widely spread to the world due to high mortality among the nations we tried to evaluate the efficacy of methylprednisolone pulse in COVID-19 patients with severe respiratory failure.Methods: This study was phase2, double-blind, randomized, clinical trial in adults with COVID-19 (aged ≥18 years old) admitted to the intensive care unit (ICU) of *. Patients with intermediate or severe COVID-19 with PaO2/FiO2 less than 300 and progressive disease unresponsive to standard treatments admitted to ICU. Patients were randomly allocated in either control or investigation group. The control group received recommended regimen for COVID-19. The investigation group received the recommended regimen plus Methylprednisolone (1000mg/day for three days) and oral prednisolone 1mg/kg with tapering of dose within ten days. Results: A total of 29 ICU patients with intermediate or severe COVID-19 pneumonia recruited in this study. Fourteen patients (4 female, ten male) allocated in the investigation group, and 15 patients (6 female, nine male) assigned to the control group. The participant’s average age was 64.03±13.545 (case: 61.07±12.83, control: 66.80±14.03). The patients with methylprednisolone pulse had significantly higher systolic (P=0.018) and diastolic (P=0.001) blood pressure, meanwhile, the Glasgow coma scale (GCS) of methylprednisolone group was considerably (P<0.001) higher, and by the improvement in SpO2 of methylprednisolone group none of these patients needed mechanical ventilation.Conclusion: This study demonstrated methylprednisolone pulse in COVID-19 severe respiratory failure dramatically improves the clinical condition of patients including, GCS, and SpO2 of patients.Clinical Trial Registration Number: IRCT20200406046963N1