Search

Key Clinical Message Pulsed dye laser (PDL) has proven effective in resolving lupus miliaris disseminatus faciei (LMDF) where drug therapies have failed with a lack of treatment consensus for LMDF, considering early PDL intervention is crucial to achieve resolution without scarring, prevent relapse, and enhance overall treatment outcomes. Abstract Lupus miliaris disseminatus faciei (LMDF) is a rare inflammatory and granulomatous dermatologic disease that primarily affects the face. The optimal treatment for LMDF remains controversial, and there is a lack of consensus on the most effective therapy. This case report highlights the successful use of a 595 nm pulsed dye laser (PDL) in the treatment of LMDF following unsuccessful drug therapy. A 28‐year‐old male presented with reddish‐brown eruptions on his face that had persisted for several months. Clinical examination revealed discrete dome‐shaped eruptions in clusters on the central area of the face. Histopathological examination confirmed the diagnosis of LMDF, based on the presence of epithelioid granulomas with central caseous necrosis. Previous treatment with an oral isotretinoin and methotrexate combination also failed to yield satisfactory results. After discontinuing drug therapy, the patient underwent five sessions of PDL treatment. Ten days after the first session, the eruptions began to regress without scarring. Subsequent PDL sessions led to the complete resolution of the eruptions. The patient experienced no relapse during the follow‐up period. This case report suggests that PDL treatment may be an effective option for LMDF, particularly in cases where drug therapy has failed. Early initiation of laser treatment may prevent scarring, minimize the adverse effects associated with drug therapy, and reduce the risk of disease relapse. Further research and controlled trials are needed to establish the efficacy of laser therapy in the treatment of LMDF.

Abstract Background Lophomonas blattarum is an emerging protozoan that mostly infects the lower respiratory tract and causes pulmonary lophomoniasis. Radiologic findings in patients with pulmonary lophomoniasis have yet to be studied. Thus, we conducted a registry-based clinical investigation to evaluate the radiologic findings of lophomoniasis. Methods In this cross-sectional study, 34 Lophomonas positive patients were enrolled. Demographic data, relevant characteristics, and radiologic findings of the patients were recorded and analyzed. Results Thirty-four (male = 18, female = 16) patients with an average age of 52.21 ± 20.48 years old were examined. Radiological findings such as Alveolar consolidation (26.5%), Ground glass opacity (5.9%), Centrilobular nodules (23.5%), Tree -in- bud (38.2%), Cavitation (23.5%), Pleural effusion (23.5%), Interstitial opacity (8.8%), Lymphadenopathy (23.5%), Bronchocele (5.9%), Bronchiectasis (29.4%), Nodules (8.8%) and Mass (11.8%) were obtained, that the frequency of all radiological findings was less than 50%. Conclusion In this study, the most common radiological findings in patients with lophomoniasis were tree-in-bud nodules, alveolar consolidation, bronchiectasis, and centrilobular nodules which were mostly seen in the right lung and its middle and lower lobes. Given that the radiologic findings of this disease are unknown, it can be considered in differential diagnosis.

Background and purpose: Seborrheic dermatitis (SD) is a chronic skin condition that is accompanied by scaling and itching. Stress and mental rumination followed by the disease affect the quality of life. The aim of this study was to investigate the effect of seborrheic dermatitis on the quality of life and to compare it with the quality of life of healthy people. Materials and methods: This study was a cross-sectional study. The study sample included 60 randomly selected patients with seborrheic dermatitis who referred to Bouali and Tooba dermatology clinics in Sari during 2019-2020. Two questionnaires (DLQI and SF-36) were used to assess general quality of life in patients. Results: The relationship between the disease and occupation was statistically significant. There was a significant relationship between smoking and seborrheic dermatitis. We also found a significant relationship between the frequency of recurrences and quality of life. The mean of physical and social function in the healthy group was higher than its value for the patient group, but the difference was not significant. Conclusion: Our study showed that age, education, occupation, and smoking are factors that contribute to seborrheic dermatitis. Moreover, the findings revealed that physical and mental health as well as quality of life were less affected in the married group compared to the single group.

In this case report, we address the diagnostic challenges and clinical implications of severe infection with Lophomonas blattarum in a patient initially suspected of experiencing long COVID symptoms. We describe the patient's medical history, initial symptoms, diagnostic tests, and treatment. A female patient with diabetes in her early 60s presented with severe shortness of breath and was initially diagnosed with diabetic ketoacidosis (DKA). After resolution of her DKA symptoms, persistent respiratory issues led to a COVID-19 test, which was negative. A chest computed tomography scan revealed abnormalities, prompting bronchoscopy and bronchoalveolar lavage fluid analysis, which confirmed the presence of L. blattarum . Notably, the protozoan remained mobile and viable even after a 4-day transport at ambient temperature. This case emphasizes the importance of considering alternative diagnoses and improving awareness about L. blattarum infection in patients with respiratory symptoms, for timely and accurate management.

Background and purpose: Cryotherapy, which causes inflammation, is one of the methods used in treatment of warts. Including a topical steroid in a regular wound care regimen slows the course of damage and promotes re-epithelialization. The purpose of this study was to assess the therapeutic efficacy of topical betamethasone valerate on inflammation after cryotherapy in patients with warts compared to placebo. Materials and methods: Twenty people were included in a double blind clinical trial. Cryotherapy was used on both sides of the body to treat the lesions. Following cryotherapy, topical betamethasone was applied to the lesions on one side, while placebo ointment was applied to the lesions on the opposite side. The patient's symptoms were documented during four visits. To assess pain intensity, the visual pain scale (VAS) was used. Finally, treatment evaluation was scored during these four sessions. SPSS V16 was used to analyze the data. Results: None of the samples at the end of the study had hypertrophic or atrophic scars and depigmentation, hyperpigmentation or hypopigmentation lesions. Mean erythema, pain, frequency of blistering and frequency of edema during 14 days of follow-up were not significantly different between the two groups (P>0.05). Conclusion: During the 14-day follow-up period after therapy, topical betamethasone had no effect on the incidence of blisters and edema, as well as the average score of pain and erythema. As a result, this treatment modality cannot be used to relieve inflammation following cryotherapy in patients with warts. (Clinical Trials Registry Number: IRCT20170818035762N3)

Background and purpose: Recently, many studies have been conducted on the role of selenium in autoimmune diseases. Trace element deficiency is not an uncommon finding in autoimmune diseases. This deficiency may be a consequence of autoimmune diseases or may contribute to their aetiology. The aim of this study was to investigate the level of selenium in patients with sarcoidosis compared to healthy controls in teaching hospitals affiliated with Mazandaran University of Medical Sciences. Materials and methods: In this case-control study, serum selenium levels were measured in 42 patients with sarcoidosis and compared with 42 healthy, age- and sex-matched controls. Two cc non-fasting blood samples were collected. The serum selenium level was measured using Atomic Absorption Spectrometry (AAS). The normal range for serum selenium is between 46 to 143 micrograms per liter. Results: The mean ages in the case group and controls were 47.45±7.6 and 47.24±7.23 years, respectively (P=0.898). Serum selenium levels were significantly lower than the controls (82.42±24.11 vs. 94.79±27.01 µg/ml, P=0.03). In case group, there was no significant difference between serum selenium levels and sex (P=0.165). The study showed no relationship between serum selenium levels and age (P=0.258), duration of disease (P=0.121), duration of treatment (P=0.837), delay in initiation of treatment (P=0.316), and type of treatment (P=0.859). Conclusion: Serum selenium levels were significantly lower in patients with sarcoidosis than the healthy controls, so, these patients may benefit from selenium supplements.

Abstract Background The characteristics of people admitted to psychiatric wards act as one of the indicators of the performance of the service system as a whole. The characteristics of these people and how they are referred to psychiatric hospitals vary in different communities. The aim of this study was to investigate the demographic and clinical characteristics of patients with mental disorders who were referred to Zare Hospital in Sari, the capital of Mazandaran province in the north of Iran, in 2020, based on their referral sources in order to better provide a health care system. Results The mean age of patients (male = 827, female = 293) was 38.25 ± 11.88. 84.2% were referred by family, 12.7% by judicial authorities, 1.7% by police, 0.9% by themselves, and 0.5% by other sources. The most common cause of referrals in all cases was aggression, and the most common diagnosis class was psychotic disorders with the highest frequency in the family referral group. About 21% of patients had methamphetamine abuse, of which about 20% were referred by the court and police. Conclusions The high prevalence of aggression and substance abuse raises the need to set up special services for such patients with the cooperation of mental health professionals, judicial authorities, and the police.

Background and purpose: Computed tomography (CT) scan is of great help in confirming the diagnosis of tuberculosis (TB) before the sputum test result. The purpose of this study was to investigate the relationship between pulmonary involvement patterns in CT scans of TB patients with positive sputum smears. Materials and methods: This retrospective descriptive-analytical study was conducted using the records of TB patients admitted to Ghaemshahr Razi Hospital between 2012 and 2018. Demographic information and CT scan reports were collected and compared with the sputum smear results. Results: The records of 271 patients (185 men and 86 women) with an average age of 49.31±15.08 years were examined. Sputum smears were positive in 191 (70.5 %) patients and negative in 80 (29.5 %). The most prevalent lesions were cavitation (72.7%) and consolidation (42.8%), and the most common locations were the upper lobe of the right lung (61.3%) and the upper lobe of the left lung (53.5%). Cavitary and consolidation lesions were significantly more common in patients with smear positive TB (P

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 In the years since the start of the COVID‐19 pandemic, numerous neurological manifestations have been reported following this novel virus. Myasthenia gravis is one of them. Here, we present the patient that was referred to us with myasthenia gravis symptoms after a COVID‐19 infection.

Abstract A prospective study was conducted from 2017 to 2021 at Bouali Hospital in Mazandaran province, Sari, Iran. Out of 58 patients who were enrolled in our study, lophomoniasis was diagnosed in bronchoalveolar lavage fluid of nine patients, for the first time, using an in‐house polymerase chain reaction technique. All patients were treated with metronidazole at 7.5 mg/kg/day every 12 h for 14 days. After 6 months of follow‐up, symptoms were fully resolved.

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 In this article, we report a patient referred to the clinic of Imam Khomeini Hospital in Sari, Mazandaran, northern Iran, with a 3‐month complaint of chronic cough and weight loss. According to the chest computed tomography scan, a cavity was detected in the upper lobe of the patient's left lung. The patient had no history of smoking or underlying diseases that predisposed him to cavitation, including tuberculosis. Then, bronchoscopy was performed for the patient, and bronchoalveolar lavage fluid was sent to the Iranian National Registry Center for lophomoniasis, and Lophomonas blattarum was detected in samples. Finally, the patient's symptoms were totally resolved by prescribing third‐daily metronidazole for 2 weeks.

Background. Lophomonas blattarum is an emerging protozoan agent that mainly infects the lower respiratory system, causing pulmonary lophomoniasis. The bronchoscopic findings in patients with pulmonary lophomoniasis have not been investigated yet. Accordingly, we assess the bronchoscopic findings of lophomoniasis in patients suffering from pulmonary lophomoniasis through a registry-based clinical study. Methods. In this retrospective study, of 480 patient candidates for bronchoscopy, 50 Lophomonas-positive patients were enrolled. Demographic data, relevant characteristics, and bronchoscopy findings of the patients were recorded and analyzed. Results. Overall, 50 (male = 32, female = 18) patients with an average age of 61.8 ± 13.3 years were examined. Nineteen patients (38%) had normal bronchoscopic findings, and 31 patients (62%) had abnormal bronchoscopic findings. According to the severity index, most (52%) of patients had mild severity, followed by moderate (30%) and severe (18%) cases. The highest involvement was in the right lung bronchus (46%), and the lowest was in the carina (8%). Furthermore, purulent and mucosal secretions in the right and left lung bronchus were the most abnormalities found in different anatomical locations. Conclusion. For the first time, the current study demonstrated that pulmonary lophomoniasis does not have pathognomonic bronchoscopic findings. However, each suspected patient must be checked for lophomoniasis, even with normal bronchoscopic findings, particularly in endemic areas.

Objectives. Lophomonas protozoan is an emerging pathogen transmitted through arthropods such as cockroaches. Lophomoniasis is still a mysterious disease with many unknown epidemiological aspects. The current study aimed to determine the prevalence of lophomoniasis among patients who were hospitalized in Hajar Hospital, Shahrekord, southwestern Iran, using a conventional PCR technique. Methods. In this retrospective study, 132 frozen bronchoalveolar lavage fluid (BALF) specimens from patients with respiratory disorders hospitalized in Hajar Hospital, Shahrekord district, southwestern Iran, were analyzed during 2020-2021. Samples are referred to the Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran Province, Northern Iran, for detecting Lophomonas spp. infection by a conventionally small subunit ribosomal RNA (SSU rRNA) PCR test. Results. A total of 132 frozen BALF specimens were examined, 36 (27.3%) tested Lophomonas spp. positive using the conventional PCR technique. Also, based on sequencing data and blast analysis, the presence of L. blattarum species was confirmed. The average age of Lophomonas spp.‐ positive patients was 67.02 ± 15.14 years. Out of the 36 positive subjects, 63.9% were male and 36.1% female. Male and Lophomonas infection had a significant correlation (p=0.001). Our findings revealed that L. blattarum infected nonsmokers more than smokers (p=0.001). The most common underlying disease was also bronchitis Conclusion. Our results showed, for the first time, that pulmonary lophomoniasis caused by L. blattarum is a common and emerging disease in the study area, southwestern Iran. Furthermore, our findings support the use of the PCR test to detect Lophomonas infection in archived frozen clinical samples.