SARS-CoV-2 Infection Related Hyperglycemia during hospitalization and three months post-discharge (preprint)

Hyperglycemia or diabetes mellitus during COVID-19 has always been a great concern and heralds severe forms of the disease, we also don’t know whether this condition will continue as diabetes mellitus even after convalescence. For this purpose we conducted a study to investigate this condition and factors related to it in hospitalized patients and even three months post-discharge we followed them up. We gathered data from 202 patients that fulfilled our inclusion criteria, among them 100 patients were hyperglycemic. Patients in hyperglycemic status experienced significantly longer duration of hospitalization than normoglycemic patients and significantly showed more severe forms of the disease. During their follow up three months post-discharge for the investigation of glycemic status, 46 out of 97 patients were diagnosed with diabetes mellitus and have been taking anti-diabetic drugs while 29 patients only had normal glycemic status.

Recurrent culture-negative endocarditis and osteomyelitis caused by Q fever in Iran, a case report (preprint)

Background: Endocarditis is an infection of the endocardial layer of the heart known as fatal infection. Gold standard diagnosis of infectious endocarditis is blood culture, which in some cases can be negative. In blood culture-negative endocarditis, the early diagnosis, and treatment are much harder, which can increase morbidities and also mortality. Case presentation: In this case report we are presenting a patient with intermittent fever for three months with a history of aortic and pulmonary valve replacement and also recurrent blood culture-negative endocarditis. According to the pandemic situation, we checked the Covid-19 PCR and also performed a chest computed tomography (CT) -scan, which both were negative and did not represent any pathologic conditions. Other examinations such as transesophageal echocardiography (TEE) and blood cultures were all normal and the only abnormal finding we had was a positron emission tomography (PET) - CT scan with endocarditis and sternum osteomyelitis evidence. Conclusion: After several evaluations based on endemic epidemiology, the Real-time PCR and IFA (IgG phase I; 1:16384, IgG phase II; 1:16384) were positive for Q fever and the patient responded to the proper doxycycline and hydroxychloroquine treatment.

Development of Disseminated Tuberculosis in A Non-Immunocompromised Patient After COVID-19 Infection: A Case Report (preprint)

Background: COVID-19 pandemic has had complications and has changed the pattern of disease incidence. COVID-19 affects the immune system. We present a case of disseminated tuberculosis (TB) in non-immunocompromised person with a history of COVID-19 infection. Case presentation A 25 year old woman had a history of mild COVID-19 infection 3 months ago. Then the complaint of back pain began and the headache was added 1 months later. Gradually, the patient’s headache intensified. Finally, the patient was admitted with decreased level of consciousness, delirium and focal neurological symptoms. The work up confirmed disseminated TB contain of miliary pulmonary TB, TB meningitis and TB spondylodiscitis. The patient gradually improved on anti-tuberculosis treatment. Conclusions: There may be an association between disseminated TB infection following COVID-19 infection.

Safety and Effectiveness of High-Dose Vitamin C in Patients with COVID-19; A Randomized Controlled open-label Clinical Trial ‎ (preprint)

Background: To assess the effectiveness of vitamin C treatment against coronavirus disease 2019 (COVID-19) Methods: An open-label, randomized, and controlled trial was conducted on patients with severe COVID-19 infection. The case and control treatment groups each consisted of 30 patients. The control group received lopinavir/ritonavir and hydroxychloroquine and the case group received high-dose of vitamin C (six gr daily) added to the same regimen. Results: There were no statistically significant differences between two groups with respect to age and gender, laboratory results, and underlying diseases. On the 3 rd day of hospitalization, the mean core body temperatures was significantly lower and SpO2 was higher In the case group (p value = 0.001, and 0.014, respectively). The median length of hospitalization in case group which was significantly longer than the control group (8.5 days vs. 6.5 days) (p value = 0.0280). There was no significant difference in SpO2 levels at discharge time, the length of ICU stay, and mortality between the two groups. Conclusions: : We did not find significantly better outcomes in the group who were treated with high-dose vitamin C in addition to the main treatment regimen at discharge. Trial registration: The project was registered by Iranian Registry of Clinical Trials.IRCT20200411047025N1

COVID-19 in Iran, a comprehensive investigation from exposure to treatment outcomes (preprint)

Background There is a growing need for information regarding the recent coronavirus disease of 2019 (Covid-19). We present a comprehensive report of Covid-19 patients in Iran.Methods One hundred hospitalized patients with Covid-19 were studied. Data on potential source of exposure, demographic, clinical, and paraclinical features, therapy outcome, and post-discharge follow-up were analyzed.Results The median age of the patients was 58 years, and the majority of the patients (72.7%) were above 50 years of age. Fever was present in 45.2% of the patients on admission. The most common clinical symptoms were shortness of breath (74%) and cough (68%). Most patients had elevated C-reactive protein (92.3%), elevated erythrocyte sedimentation rate (82.9%), lymphocytopenia (74.2 %) on admission. Lower lobes of the lung were most commonly involved, and ground-glass opacity (81.8%) was the most frequent finding in CT scans. The administration of hydroxychloroquine improved the clinical outcome of the patients. Lopinavir/ritonavir was efficacious at younger ages. Of the 70 discharged patients, 40% had symptom relapse, (8.6%) were readmitted to the hospital, and 3 patients (4.3%) died.Conclusions  This report demonstrates a heterogeneous nature of clinical manifestations in patients affected with Covid-19. The most common presenting symptoms are non-specific, so attention should be made on broader testing, especially in age groups with the greatest risk and younger individuals who can serve as carriers of the disease. Hydroxychloroquine and lopinavir/ritonavir (in younger age group) can be potential treatment options. Finally, patients discharged from the hospital should be followed up because of potential symptom relapse.

COVID-19 in Iran, a comprehensive investigation from exposure to treatment outcomes (preprint)

Purpose There is a growing need for information regarding the recent coronavirus disease of 2019 (Covid-19). We present a comprehensive report of Covid-19 patients in Iran. Methods One hundred hospitalized patients with Covid-19 were studied. Data on potential source of exposure, demographic, clinical, and paraclinical features, therapy outcome, and post-discharge follow-up were analyzed. Results The median age of the patients was 58 years, and the majority of the patients (72.7%) were above 50 years of age. Fever was present in 45.2% of the patients on admission. The most common clinical symptoms were shortness of breath (74%) and cough (68%). Most patients had elevated C-reactive protein (92.3%), elevated erythrocyte sedimentation rate (82.9%), lymphocytopenia (74.2 %) on admission. Lower lobes of the lung were most commonly involved, and ground-glass opacity (81.8%) was the most frequent finding in CT scans. The administration of hydroxychloroquine improved the clinical outcome of the patients. Lopinavir/ritonavir was efficacious at younger ages. Of the 70 discharged patients, 40% had symptom relapse, (8.6%) were readmitted to the hospital, and 3 patients (4.3%) died. Conclusion This report demonstrates a heterogeneous nature of clinical manifestations in patients affected with Covid-19. The most common presenting symptoms are non-specific, so attention should be made on broader testing, especially in age groups with the greatest risk and younger individuals who can serve as carriers of the disease. Hydroxychloroquine and lopinavir/ritonavir (in younger age group) can be potential treatment options. Finally, patients discharged from the hospital should be followed up because of potential symptom relapse.