Late diagnosis of respiratory syncytial virus and influenza co-infection during coronavirus disease 2019 pandemic: a case report.

BACKGROUND: Respiratory syncytial virus (RSV)-induced disease is one of the important causes of flu-like illness in older adults and can cause serious disease in those who are at high-risk medical conditions. During coronavirus disease 2019 (COVID-19) pandemic, because of overlapping symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection with other respiratory infections, diagnosing diseases based on clinical and radiological findings was challenging and could cause misdiagnosis. CASE PRESENTATION: An 87-year-old Persian man was admitted to the hospital due to loss of consciousness, respiratory distress, tachypnea, and oliguria. He had previously hospitalized because of cough, fever, loss of appetite, and fatigue. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) test was performed which was negative; however, based on ground glass opacity on his chest computed tomography (CT) scan and being on the outbreak of COVID-19, he fulfilled case definition of COVID-19; therefore, he received protocol's treatment (remdesivir) for COVID-19 and relatively recovered and discharged. In our center, we requested brain and chest CT scans, blood tests, and multiplex PCR. Multiplex PCR revealed co-infection of influenza virus and RSV. Although we had started pneumonia and sepsis treatment, old age, weak immune system and the delay in initiation of right antibiotic and antivirus therapy altogether led him to die. CONCLUSION: As a takeaway lesson of this case report, it is necessary to pay attention to viruses that show similar symptoms during future specific virus pandemics, especially in patients with old age and weak immune systems.

The effect of vitamin D and magnesium supplementation on clinical symptoms and serum inflammatory and oxidative stress markers in patients with COVID-19: a structured summary of a study protocol for a randomized controlled trial.

OBJECTIVES: This study aims to evaluate the effect of vitamin D and magnesium supplementation on clinical symptoms and serum inflammatory and oxidative stress markers in patients with COVID-19. TRIAL DESIGN: This study is a 4-arm randomized, double-blind, placebo-controlled clinical trial with a factorial design and the intervention period is 3 weeks. PARTICIPANTS: This study is conducted on COVID-19 patients admitted to the Shahid Mohammadi hospital in Bandar Abbas, Iran, who are eligible for inclusion in the study. Patients are included only if they meet all of the following criteria: (1) aged from 18 to 65 years old; (2) confirmation of COVID-19 by RT-PCR test; (3) completing informed consent; (4) passing less than 48 h since the patient's hospitalization; (5) no skin or gastrointestinal allergies due to taking multivitamin supplements, vitamin D, and magnesium; and (6) having more than 30 breaths per minute and less than 93% oxygen saturation in room air and sea level. Patients are excluded if they have any of the following conditions: (1) pregnancy or lactation; (2) taking a daily multivitamin or take a vitamin D or magnesium supplement in the last month; (3) participating in other clinical trials; (4) renal failure or dialysis, severe liver disease or cirrhosis; (5) known diagnosis of hypercalcemia; (6) discharging from the hospital less than 24 h after the start of the intervention; (7) history of kidney stones in the last year; (8) transfer the patient to the ICU; (9) baseline vitamin D levels above 80 ng/ml; (10) baseline magnesium levels above 2.6 mg/dl; and (11) unwillingness of the patient to continue the study. INTERVENTION AND COMPARATOR: Participants will be randomly allocated to one of the four following groups: (A) vitamin D (two 50,000 IU capsules at the beginning of the study, two 50,000 IU capsules on the 4th day, one 50,000 IU capsule on the 11th day, and one 50,000 IU capsule on the 17th day) and magnesium supplement (300 mg/day); (B) vitamin D capsule and magnesium placebo; (C) magnesium supplement and vitamin D placebo; and (D) vitamin D placebo and magnesium placebo. MAIN OUTCOMES: The resolution of clinical symptoms (fever, dry cough, shortness of breath, headache, myalgia, oxygen saturation, and mortality rate) and interpretation of laboratory assays (CRP, MDA, TAC, WBC, neutrophils count, lymphocytes count, ratio of neutrophils to lymphocytes, levels of 25 hydroxyvitamin D and magnesium) will be assessed in the study groups. RANDOMIZATION: A computer-generated block randomization list is used for randomization. BLINDING (MASKING): Investigators and patients are blinded to group allocation and treatment. A double-blind design is achieved using matched placebos. NUMBERS TO BE RANDOMIZED (SAMPLE SIZE): A total of 104 eligible patients are randomized into four groups of 26 subjects (1:1:1:1 allocation ratio). DISCUSSION: With the rapid prevalence of COVID-19 in recent years, more attention has been paid to effective dietary supplementation to improve clinical symptoms and biochemical parameters in these patients. To our knowledge, this is the first study to evaluate the effects of vitamin D supplementation in combination with magnesium or alone with respect to this infectious disease. The findings of the current RCT will provide evidence regarding the effectiveness of dietary supplementation strategies to improve COVID-19 outcomes. TRIAL STATUS: Ethical approval of the first version of the study protocol was obtained from the medical ethics committee of Hormozgan University of Medical Sciences, Bandar Abbas, Iran on May 30, 2021 (IR.HUMS.REC.1400.085). Currently, the recruitment phase is ongoing since August 23, 2021, and is anticipated to be complete by the end of August 2022. TRIAL REGISTRATION: The study protocol was registered in the Iranian Registry of Clinical Trials ( https://www.irct.ir ; IRCT20210702051763N1) on August 14, 2021. https://www.irct.ir/trial/57413 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this letter serves as a summary of the key elements of the full protocol.

Colonic basidiobolomycosis in a patient with systemic lupus erythematosus (SLE).

BACKGROUND: Basidiobolus ranarum belongs to the Entomophthorales order and the Zygomycetes class. This fungus is an environmental saprophyte that can be found in soil and rotting vegetables.Primarily restricted to tropical regions including Asia, Africa, and South America. It might cause chronic inflammatory diseases, mostly affect subcutaneous tissue. Systemic infections involving the gastrointestinal tract are extremely rare. CASE PRESENTATION: Herein, we present a 44-year-old Persian man with the past medical history of lupus erythematosus with colicky abdominal pain started from three months before admission with many vomiting episodes, and a mass on the right lower quadrant, who had been thought initially to have an abdominal malignancy. The patient had vital signs were within normal ranges. His physical examination revealed tenderness and rebound tenderness on the right lower quadrant of the abdomen. A fixed mass 10 × 10 centimeter in diameter was palpated in the same quadrant. Laboratory, radiologic, colonoscopic examination was requested. The patient underwent laparotomy which revealed a mass in the terminal ileum and ascending colon with retroperitoneal adhesion and invasion to the right ureter behind it. Pathologic examination showed basidiobolomycosis infection in the specimen. CONCLUSION: Fungal infection should be among the differential diagnoses for adults present with abdominal mass in endemic regions of the world.

Omental torsion mimicking acute appendicitis in a 7-year-old boy: a case report.

BACKGROUND: Torsion of the greater omentum is an uncommon cause of acute abdominal pain. Omental torsion can be divided into primary and secondary. Owing to its nonspecific abdominal pain, preoperative diagnosis is difficult. Ultrasound sonography and abdominal computed tomography scans do not have a major role in preoperative diagnosis. The definite diagnosis is usually made during operation. CASE PRESENTATION: A 7-year-old Persian boy was referred with right lower quadrant pain associated with nausea and vomiting. Laboratory blood tests and urinalysis were requested that revealed normal values. Ultrasonography was performed, revealing inflammatory changes with mild free fluid collection in the interloop. The patient underwent an open appendectomy, confirming a normal appendix with omental torsion. Two days later, he was discharged home without postoperative complications. CONCLUSIONS: In patients with acute abdomen, particularly those with acute appendicitis symptoms, omental torsion should be considered in the differential diagnosis.

Late presentation of congenital type IV esophageal hiatus hernia in a 9-year-old boy: a case report.

BACKGROUND: Congenital diaphragmatic hernia affects 1 in every 2000-5000 live births. The mediastinum shifts to the opposite side, the lungs are hypoplastic, and the arterioles are abnormal, resulting in pulmonary hypertension. Respiratory and cardiovascular functions are severely impaired at birth, resulting in significant mortality and morbidity as a result of the associated malformations. CASE PRESENTATION: A 9-year-old persian boy was referred with complaint of intermittent abdominal pain in the left lower quadrant and an episode of vomiting. The patient was tachypneic, and the abdomen was nontender on examination. Lung sounds on the left side were considerably decreased, whereas heart sounds on the right side were louder. There was no history of underlying disease in the patient. Initial laboratory blood tests, chest x-ray, spiral computed tomography scan, and chest sonography were requested. Blood tests were normal, and chest x-ray revealed a round-shaped lesion with relatively clear boundaries containing air-fluid level and shift of the heart and mediastinum to the right. A spiral computed tomography scan of the lungs demonstrated the shift of the heart and mediastinum to the right side was due to dilated stomach and colon pressure, and chest sonography revealed that half of the stomach was inside the thorax. Laparotomy surgery was performed. The patient had no complications following surgery. CONCLUSIONS: Herniation of abdominal contents through the diaphragmatic hiatus should be suspected in patients with tachypnea and mediastinal shift to the right side. Rapid diagnosis and early surgical treatment are necessary to avert any potentially life-threatening complications.