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Mucosal leishmaniasis (ML) is a chronic and rare form of leishmaniasis that causes malignant lesions in the mucosa of the nasal, pharyngeal, and laryngeal regions. We describe a 29-year-old woman who had been suffering from an intranasal polyp for 3 years. The polyp recurred annually after surgical removal, and was diagnosed as nasal leishmaniasis.

Abstract Trichobezoars are hairballs in the gastrointestinal tract that usually develop due to the consumption of hair after pulling it. However, some rare case reports suggest that trichobezoar can also occur in the respiratory system. In this context, we present an unusual case of a 25‐year‐old woman who experienced dyspnea, productive cough, and leukocytosis. The patient was found to have a trichobezoar in her respiratory tract, accompanied by the presence of hair in her digestive tract.

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.

Introduction. Bronchopulmonary lophomoniasis (BPL) is a protozoan pulmonary disease that has been reported sporadically, but its incidence has been increasing. However, the epidemiology and risk factors of the disease have not been clearly identified. The current study aims to identify BPL cases molecularly and assess the demographic and some environmental factors for the first time on the prevalence of BPL as a national registry-based study in Iran. Methodology. The study tested 960 patients with lower respiratory tract symptoms whose bronchoalveolar lavage samples were submitted from seven provinces of Iran to the Iranian National Registry Center for Lophomoniasis. They were tested for BPL by a newly developed polymerase chain reaction test. The study assessed the association of Normalized difference vegetation index (NDVI), digital elevation model (DEM), and geographic latitude as environmental factors and sex and age as demographic factors on the prevalence of BPL. Geospatial information systems methods and chi-squared and Pearson’s correlation tests were used for the assessment of geographical and environmental factor effects and statistical analysis, respectively. Results. Of the 960 patients, 218 (22.7%) tested positive for BPL; the highest and lowest prevalence rates were reported from the south and northeast of Iran, respectively. The study found a correlation between geographic latitude and age with BPL prevalence, but no association was found for gender, NDVI, or DEM. Most patients were over 40 years old, and the rate of disease was higher in southern latitudes. Conclusion. Age and geographical latitude were found to be risk factors for BPL. More exposure to dust and/or chronic pulmonary problems may explain the higher prevalence of the disease in older adults. Higher rates of BPL in lower latitudes may be due to warmer weather and longer days, which can confine individual activities indoors and result in more contact with domestic insects and infected dust.

Abstract One of the contributing causes of hypertension or exacerbation of ischemic heart disease (IHD) has been suggested to be environmental pollution and occupational exposure to particular metals, such as lead. Here, we describe a 43‐year‐old man with a history of oral opium with symptoms of IHD due to chest pain.

Abstract We report a 52‐year‐old patient with a history of breast cancer (BC) referred to the clinic of Afzalipour Hospital, in Kerman, eastern Iran, with a 1‐week complaint of restless dyspnea. A chest computed tomography scan revealed consolidations in the upper lobes of both lungs. The patient had no history of smoking or underlying diseases that would predispose her to consolidation, including pneumonia. Then, bronchoscopy was performed for the patient, and bronchoalveolar lavage fluid was sent to the Iranian National Registry Center, where the Lophomonas parasite was detected in the sample and confirmed using a polymerase chain reaction test. Finally, her symptoms improved by receiving oral metronidazole three times a day for 3 weeks.

Abstract Individuals who introduce illicit substances such as opioids and amphetamines into the gastrointestinal tract by swallowing or inserting them into the rectum are known as body packers. We describe a prisoner who developed severe poisoning symptoms after swallowing amphetamine packets and was promptly removed by laparotomy.

Propranolol, a β-blocker (BB), is one of the drugs that can be misused for suicide. The clinical manifestations of overdose can range from asymptomatic to neurological symptoms such as seizures and loss of consciousness, cardiac shock, and even death. Herein, we describe 2 cases that were referred to our hospital’s emergency department in northern Iran: The first case was a 37-year-old woman who suffered from a decreased level of consciousness, bradycardia, and hypotension after ingesting 4 g of propranolol tablets. In the second case, a 32-year-old woman was admitted with complete cardiac arrest and a suspected history of ingesting 4.8 g of propranolol pills a few hours before admission. Therefore, the time interval between pill intake and treatment initiation seems to be one of the most important factors in prognosis, in addition to the number and dosage of pills ingested.

Abstract The majority of rectal foreign bodies inserted by adults are for self‐gratification. As a result, they will probably be smooth, rounded, tubular, or egg‐shaped to make insertion and extraction easier. Herein, we describe a 50‐year‐old man who inserts a water bottle into a region 10 mm from the anorectal junction.

Opium addiction can cause symptoms in the central or peripheral neurological systems, as well as gastrointestinal disorders and anemia; in such situations, lead poisoning should be considered and chelation therapy should be started as soon as possible. In adults, lead poisoning is an unusual cause of abdominal pain. A common form of lead neuropathy includes weakness of the wrist and finger extensors. We describe a 24-year-old female who developed severe lead poisoning after 3 years of opium consumption, leading to gastrointestinal complaints and bilateral wrist drops.

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.

Abstract 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.

Abstract Cutaneous leishmaniasis is one of the most common forms of leishmaniasis in Afghanistan, which is caused by different Leishmania species that are transmitted to humans by sandflies. Its clinical manifestations are very diverse and depend on a variety of parasite and host factors.

Abstract Mucormycosis is a fungal infection that can affect a variety of organs, one of which being the respiratory system. The most common form of infection with mucormycetes is pulmonary mucormycosis, which has a poor prognosis if infected. The clinical signs and radiological findings of this infection are non‐specific and very similar to lung tumours. Here, we describe a 62‐year‐old obese man with uncontrolled diabetes mellitus who was referred for a tumour‐like mass in the left lung, which after bronchoscopy was diagnosed as mucormycosis.

Abstract 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.

Abstract Lophomonas is a neglected and emerging protozoan that infects the lower and upper respiratory tracts of humans. Here, we present two cases of lophomoniasis from Afghanistan that include symptoms such as fever, cough, hemoptysis, and pleural effusion.

Abstract Immunocompromised patients are frequently more susceptible to pathogens such as protozoa. For the first time, we report a case of pulmonary lophomoniasis in a known case of acute myeloid leukaemia (AML‐2) from Qeshm Island, Persian Gulf, southern Iran. Diagnosis of lophomoniasis was confirmed using microscopy and molecular examinations of bronchoalveolar lavage fluid. She was completely treated with metronidazole (500 mg three times a day for 3 weeks). We conclude that immunocompromised patients with unjustified respiratory disorders should be screened for Lophomonas infection.

Abstract Cystic echinococcosis is one of the most important zoonotic parasitic diseases caused by the tapeworm Echinococcus granulosus. To date, the genotype of multivesicular CE has not been identified. In this regard, the genotyping of multivesicular types of CE could help clinicians understand and manage the disease effectively.

Abstract Loss of consciousness (LOC) is one of the most common causes of emergency department (ED) visits. It may be due to intoxication or hypoglycemia. We present a 15‐year‐old girl who was referred with heavy head lice and LOC to the ED in the north of Iran.

Abstract 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.

Abstract Donepezil and acetyl cholinesterase inhibitors are the most commonly prescribed medications for the treatment of Alzheimer's disease. We describe a 2‐year‐old infant who was referred to the emergency department after developing cholinergic syndrome 6 hours after ingesting 10 mg of his grandmother's donepezil tablets and was finally discharged in stable condition.

Background: There are not many studies on relationship between teamwork in pre-hospital Emergency Medical Services (EMS) and the relationship between teamwork and its consequences is complicated. Objectives: Therefore, the goal of this research is studying the degree of teamwork and its relationship with job and demographic factors of the Emergency Medical Technicians (EMTs) in Zanjan Province. Methods: This cross-sectional study focused on the correlation between inclination to teamwork and the demographic features of the EMTs, using a researcher-made demographic and job features instrument and Patterson’s EMT-Teamwork scale. The data were analyzed through the SPSS. 16 software, and p

Abstract Although acute kidney injury (AKI) is a very rare complication of tramadol (TR) poisoning, overdose use in recent years should be considered. We present a 21‐year‐old man with metabolic acidosis, seizures, elevated serum creatine phosphokinase (CPK), creatinine, and rhabdomyolysis due to tramadol poisoning.

Abstract Anaphylactic shock is an unexpected, life‐threatening, and sometimes fatal occurrence that affects patients in 75% of instances without a prior history of allergies. The severity of the reaction can vary among individuals. We report a case who died suddenly after being stung by bees in various parts of his body.

Abstract 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.

Abstract Background Zinc phosphide (ZnP) is a dark gray crystalline compound used as a rodenticide against rodents such as mice. ZnP poisoning may be accidental or suicidal. The aim of this study was to investigate the clinical manifestations and treatment management of hospitalized patients with ZnP poisoning in Mazandaran Province, northern Iran. Methods Between 2013 and 2017, a cross-sectional study was performed on hospitalized patients with ZnP poisoning who were referred to two training hospitals in Mazandaran Province, northern Iran. Results A total of 127 patients participated in this trial, including 71 (55.9%) men and 56 (44.1%) women. The patients’ average (standard deviation) age was 25.5 (±16.82) years, and it took 2.18 (±2.23) hours to refer them to the hospital. There were 42 (33%) cases with less than one package, 9 (7%) cases with several packages, and 76 (60%) cases with no particular usage. Conclusions This study has shown that ZnP poisoning may be asymptomatic initially or with mild clinical symptoms that may gradually worsen. Therefore, hospitalization and obtaining a history and a careful physical examination should be considered.