Fatal outcome due to aluminum phosphide poisoning in an old man with a psychiatric disorder as a latent post-COVID-19 challenge: A case report.

Aluminum phosphide is a metal phosphide widely implemented as a pesticide. In the country of Iran, it is recognized by the colloquial name of rice pill. Any trace of accidental or intentional ingestion of aluminum phosphidecan result in severe hemodynamic disorders and metabolic acidosis, ultimately leading to the patient's mortality. In this report, we document the unfortunate demise of an 85-year-old man who lived in isolation, having lost his wife to COVID-19. The patient consumed aluminum phosphide tablets and, despite resuscitation efforts, inevitably succumbed to the toxic effects.

Detection of Lophomonas in pericardial effusion sample in a COVID-19 patient with systemic sclerosis: An unusual case report.

Systemic sclerosis is a connective tissue disorder that involves the skin and many other organs, such as the heart, skin, and gastrointestinal tract. Cardiac involvement is in the form of pericarditis, pericardial effusion, and pulmonary hypertension. Several complications and super infections post-COVID-19 have been reported, such as fungal, bacterial infections, and Lophomonas blattarum. Lophomoniasis is an emerging pulmonary infection that mainly involves the lower respiratory tract. Herein, we present an ectopic Lophomonas infection in an unusual location (pericardial effusion) in a COVID-19 patient who had systemic sclerosis.

Exploring the Association Between Latent Toxoplasma gondii Infection and COVID-19 in Hospitalized Patients: First Registry-Based Study.

PURPOSE: This study aimed to determine the possible association between Toxoplasma gondii infection and COVID-19 outcomes among 133 patients with an RT-PCR-positive test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), hospitalized at Imam Khomeini Hospital, Sari, Mazandaran Province, northern Iran, during August to November 2020. METHODS: A questionnaire was used to collect baseline data from the patients who were registered to the Iranian National Registry Center for Toxoplasmosis (INRCT). Also, blood samples were taken from each patient for detecting anti-T. gondii antibodies and T. gondii DNA using enzyme-linked immunosorbent assay (ELISA) and conventional-PCR methods, respectively. Variables related to the COVID-19 severity and outcomes were indicated based on multiple multinomial logistic regression models. RESULTS: Of 133 patients enrolled in the INRCT with COVID-19 through RT-PCR, 50 (37.59%), 52 (39.1%), and 31 (23%) suffered from mild, moderate, and severe COVID-19, respectively. 57.1% of the patients who died had severe COVID-19, while among those with other outcomes, only 18.60% had severe COVID-19 (P < 0.05). Anti-T. gondii IgG was detected in 109/133 (81.95%) patients, which was not statistically significant (P > 0.05). Among those with negative and positive anti-T. gondii IgG, 2 (8.30%) and 29 (26.60%) had severe COVID-19, respectively (P > 0.05). T. gondii DNA and anti-T. gondii IgM were not found in any of the patients. Moreover, all deaths occurred in those with moderate or severe COVID-19 and a positive anti-T. gondii IgG. CONCLUSION: To our knowledge, this is the first registry-based study concerning T. gondii infection among patients with COVID-19. Our data show the high rate of latent T. gondii infection among COVID-19 with different severity. However, there is no significant relationship between latent T. gondii infection and COVID-19 severity and outcomes. Thus, conducting multicenter studies in different geographic regions of the world could offer a better understanding of this relationship.

Diabetic ketoacidosis mimicking COVID-19 in an adolescent.

Diabetic ketoacidosis (DKA) may be associated with nonspecific symptoms such as dyspnea, tachycardia, anorexia, and vomiting that are similar to COVID-19. We describe an adolescent who was referred to the emergency department with the above symptoms and died after being discharged, regardless of the differential diagnosis and laboratory findings.

First Co-morbidity of Lophomonas blattarum and COVID-19 Infections: Confirmed Using Molecular Approach.

INTRODUCTION: Lophomoniasis is caused by Lophomonas spp., a new emerging protozoan, which commonly affects the human lower respiratory tract. The Lophomonas parasite mostly lives commensally in the hindgut of cockroaches. CASE PRESENTATION: We present the case of a 33-year-old woman, 30 weeks pregnant, who had severe COVID-19. She was intubated upon admission and began the routine COVID-19 treatment. To rule out possible super infection dual with COVID-19, microscopic examination of the patient's mini-bronchoalveolar lavage (mini-BAL) specimen, revealed L. blattarum, which was identified by the SSU rRNA-PCR and sequencing approaches (accession number: MZ093069). According to that, the patient was treated successfully with metronidazole. CONCLUSION: To prevent serious complications, lophomoniasis should be listed in co-morbidity cases of COVID-19 infection during the COVID-19 pandemic worldwide. To the best of our knowledge, this is the first co-infection of Lophomonas blattarum and COVID-19 in the world which has been confirmed using a molecular approach.

Post-COVID-19 maxillary osteonecrosis and floating maxillary teeth due to mucormycosis in two uncontrolled diabetic patients.

Mucormycosis is a rare, invasive, quickly progressing fungal infection that generally affects patients who are immunocompromised. If left untreated, the disease is characterized by progressive necrosis and is often fatal. We present two cases of post-COVID-19 mucormycosis with a history of several years of uncontrolled diabetic mellitus.

Rhino-orbito-cerebral mucormycosis in a post-COVID-19 diabetic patient: Rare case from Iran.

Rhino-orbito-cerebral mucormycosis (ROCM) is a progressive and life-threatening disease that is caused by a fungal infection. Every uncontrolled diabetic patient with a skin lesion on their head and neck, sinusitis symptoms, headache, and orbital edema should be evaluated for mucormycosis.

Viral contamination of acrylic resin removable denture bases in patients with COVID-19: A cross-sectional study.

STATEMENT OF PROBLEM: Salivary gland ducts are one of the primary targets of severe acute respiratory syndrome coronavirus 2. Moreover, saliva contains minor and major salivary gland secretions and a combination of nasopharyngeal and lung secretions. The acrylic resin bases of complete or partial removable dentures have pores and provide a favorable environment for the growth of microorganisms. PURPOSE: The purpose of this cross-sectional study was to investigate the presence of viral contamination of acrylic resin removable denture bases in patients with coronavirus disease 2019 (COVID-19). MATERIAL AND METHODS: The acrylic resin denture bases (partial and complete) of 29 patients with COVID-19 who underwent treatment in the Infectious Diseases Department of Razi Hospital in Ghaemshahr, Mazandaran, Iran, were evaluated. Samples were collected from the intaglio surface of the prostheses by direct swabbing and coding and were evaluated in a laboratory for the presence or absence of coronavirus. The relationship between hospital polymerase chain reaction (PCR) and denture PCR and the relationship between denture type and denture PCR were evaluated with the Fisher exact test (α=.05). RESULTS: Twenty-nine patients, age range 55 to 85 years, 18 women, 3 with partial dentures and 26 with complete dentures, were evaluated. The hospital PCR test was positive in 28 patients, while the denture PCR test was positive in 4 patients. No significant relationship was observed between the results of hospital PCR and denture PCR in patients with COVID-19 (P=.138). All 4 patients who tested positive for denture PCR had complete dentures. No significant relationship was found between denture type and denture PCR test results in patients with COVID-19 (P=1.000). CONCLUSIONS: Despite the microporous structure of the acrylic resin base, no statistically significant viral contamination was observed.

First Co-morbidity of Lophomonas blattarum and COVID-19 Infections: Confirmed Using Molecular Approach

Introduction Lophomoniasis is caused by Lophomonas spp., a new emerging protozoan, which commonly affects the human lower respiratory tract. The Lophomonas parasite mostly lives commensally in the hindgut of cockroaches. Case Presentation We present the case of a 33-year-old woman, 30 weeks pregnant, who had severe COVID-19. She was intubated upon admission and began the routine COVID-19 treatment. To rule out possible super infection dual with COVID-19, microscopic examination of the patient's mini-bronchoalveolar lavage (mini-BAL) specimen, revealed L. blattarum, which was identified by the SSU rRNA-PCR and sequencing approaches (accession number: MZ093069). According to that, the patient was treated successfully with metronidazole. Conclusion To prevent serious complications, lophomoniasis should be listed in co-morbidity cases of COVID-19 infection during the COVID-19 pandemic worldwide. To the best of our knowledge, this is the first co-infection of Lophomonas blattarum and COVID-19 in the world which has been confirmed using a molecular approach.

Acute pancreatitis due to methanol toxicity during the COVID-19 pandemic.

Acute methanol poisoning may be associated with a variety of symptoms, such as abdominal pain, blurred vision, loss of consciousness, and acute pancreatitis. We present a 37-year-old man with acute pancreatitis due to methanol poisoning during the COVID-19 pandemic.

Post-COVID-19 co-morbidity of emerged Lophomonas infection and invasive pulmonary aspergillosis: First case report.

Due to long corticosteroid therapy in patients with COVID-19, in case of cough, dyspnea, and weight loss, emerging pulmonary aspergillosis and lophomoniasis should be ruled out.

Atorvastatin therapy in COVID-19 adult inpatients: A double-blind, randomized controlled trial.

INTRODUCTION: Efficacious therapies are urgently required to tackle the coronavirus disease 2019 (COVID-19). This trial aims to evaluate the effects of atorvastatin in comparison with standard care for adults hospitalized with COVID-19. METHODS: We conducted a randomized controlled clinical trial on adults hospitalized with COVID-19. Patients were randomized into a treatment group receiving atorvastatin + lopinavir/ritonavir or a control group receiving lopinavir/ritonavir alone. The primary outcome of the trial was the duration of hospitalization. The secondary outcomes were the need for interferon or immunoglobulin, receipt of invasive mechanical ventilation, and O2 saturation (O2sat), and level of C-reactive protein (CRP) which were assessed at the onset of admission and on the 6th day of treatment. RESULTS: Forty patients were allocated and enrolled in the study with a 1 to 1 ratio in atorvastatin + lopinavir/ritonavir and lopinavir/ritonavir groups. Clinical and demographic characteristics were similar between the two groups. CRP level was significantly decreased in the lopinavir/ritonavir + atorvastatin group (P < 0.0001, Cohen's d = 0.865) so that there was a significant difference in CRP level on the 6th day between the two groups (P = 0.01). Nevertheless, there was no significant difference in O2sat on day 6. Although the duration of hospitalization in the lopinavir/ritonavir + atorvastatin group was significantly reduced compared to the control group (P = 0.012), there was no significant difference in the invasive mechanical ventilation reception and the need for interferon and immunoglobulin. CONCLUSION: Atorvastatin + lopinavir/ritonavir may be more effective than lopinavir/ritonavir in treating COVID-19 adult hospitalized patients.

The over diagnosed COVID-19 infection in an adult patient with foreign body aspiration.

INTRODUCTION AND IMPORTANCE: Foreign body aspiration (FBA) in adults may be asymptomatic or symptomatic. Fever and cough are the most common symptoms of Coronavirus infection and other causes of pneumonia. Regardless of the etiology of pneumonia, the first step in the treatment of FBA-associated pneumonia is to remove the foreign body from the airway. CASE PRESENTATION: A 32-year-old man was referred to our emergency department on October 26, 2020 with shortness of breath (SOB) and a cough. He was referred to the medical center with clinical suspicion of Coronavirus disease-19 (COVID-19), and his disease was treated considering COVID-19. Based on the persistence of his symptoms after discharge, he was referred to the hospital again, and the presence of a foreign body was confirmed by a rigid bronchoscopy, which was then removed. CLINICAL DISCUSSION: Our patient did not remember any history of aspirating solid particles, choking, or any other high-risk conditions associated with aspiration. Also, he had no symptoms with the exception of cough and SOB before the first admission. It means that asymptomatic FBA can be tolerated and go undiagnosed, particularly in adults, and manifests as a secondary complication, such as pneumonia. CONCLUSION: The FBA and other causal agents may mimic COVID-19 pneumonia. Consequently, FBA should be included in the COVID-19 differential diagnosis.

Alkaline phosphatase and score of HRCT as indicators for predicting the severity of COVID-19.

BACKGROUND: The clinical symptoms, blood laboratory data, O2 saturation and high-resolution computed tomography (HRCT) findings are critical factors in diagnosis of COVID-19 infection. METHODS: In this study, 105 hospitalized patients suspected of having COVID-19 were evaluated. Finally, the laboratory and HRCT and related factors data of 83 confirmed cases by HRCT and RT-PCR were analyzed. To compare the median of quantitative variables in the two groups, the Mann-Whitney U test was used. Also, to determine the factors associated with the positiveness of the HRCT result, a univariate logistic model was fitted. Moreover, receiver operating characteristic (ROC) curves were constructed to test the ability of the final model to predict the positiveness of HRCT result. RESULTS: 61.40% of the patients had a comorbidity disease. 89.20% had fever, 92.00% cough, 91.40% dyspnea. Abnormal CRP was seen in 77.80% of the patients, followed by 66.70% lymphopenia, and 60.30% neutrophilia. Also, ALP (abnormal vs. normal) and score of HRCT assessment variables had a significant effect on the positiveness of HRCT findings. 87.95% had abnormal HRCT with 41% bilateral multi lobar patchy ground glass opacity (GGO). Moreover, there was a statistically significant association between the level of O2 saturation and HRCT results. CONCLUSION: Our findings showed that male patients with middle age and comorbidity disease were more susceptible to the COVID-19 infection. Additionally, clinical features, blood laboratory findings, O2 saturation and HRCT findings are critical factors in the prognosis of COVID-19 infection.

Co-morbidity of Covid-19 and Stenotrophomonas maltophilia in a Patient with Hodgkin's Lymphoma History from North of Iran.

INTRODUCTION: Immunocompromised patients, especially those hospitalized, are at a higher risk for infection with opportunistic pathogens such as Stenotrophomonas maltophilia (S. maltophilia) which is a multidrug-resistant gram-negative bacillus and can cause a challenge in the management of patients with concomitant COVID-19 and S. maltophilia pneumonia. CASE PRESENTATION: A 71-year-old man with Hodgkin's lymphoma presented with severe respiratory symptoms of COVID-19 was intubated upon admission and the initial standard treatment for COVID-19 was started for him. The patient subsequently developed superimposed bacterial pneumonia with S. maltophilia. According to that, the patient's intubation tube was removed and a tracheostomy was performed for him. Also, antibiotic treatment was replaced with Colistin and Co-trimoxazole drugs. Finally, after 31 days of hospitalization in the ICU and the appropriate drug treatment, he was discharged with reduced symptoms and partial recovery. CONCLUSION: It should be noted that the occurrence of co-infection with multidrug-resistant pathogens such as S. maltophilia requires proper management to select appropriate treatment methods and drugs, so that in addition to proper effectiveness, it does not lead to side effects and complications associated with COVID-19 disease.