Seroprevalence of SARS-CoV-2 in Mazandaran province, Iran

Objective:To determine the seroprevalance of severe acute respiratory syndrome coronavirus 2(SARS-Co V-2)antibodies in the general population of Mazandaran province in Iran and to estimate the percentage of asymptomatic,mild,and severe infections.Methods:We chose 1588 inhabitants of Mazandaran province with cluster sampling.We measured their SARS-Co V-2 immunoglobulin M(Ig M)and immunoglobulin G(Ig G)serum levels.Demographics,risk factors,and symptoms were collected.The seroprevalence of SARS-Co V-2 was calculated by age and city and the World Health Organization(WHO)protocol and further stratified by demographic variables and risk factors.Finally,we identified the symptoms and factors related to COVID-19 with logistic regression.Results:Two hundred subjects(12.59%)were tested positive for either Ig G or Ig M.Until May 23,2020,the prevalence of COVID-19 was 15.26%(95%CI:12.97%-17.79%)based on direct standardization and WHO’s standardized age groups.Based on multivariate logistic regression,the incidence of getting an infection increased by an average of 11.6%for every 10-year increase in age(OR=1.116,95%CI:1.008-1.236,P=0.035).Furthermore,those in contact with COVID-19 patients had a 66.1%higher risk of developing the disease(OR=1.661,95%CI:1.104-2.497,P=0.015).In addition,the chance of getting SARS-Co V-2 infection was almost four times higher in people who had consulted a doctor during the pandemic than those who had not(OR=3.942,95%CI:2.813-5.524,P<0.001).Conclusions:The prevalence of COVID-19 in Mazandaran province could be higher than the officially reported statistics based on diagnostic tests and clinical cases.There seems to be more asymptomatic or mild symptom cases than what was previously reported.

Conversion disorder in a neurological emergency department:Restrospective series

Objective: To observe the conversion disorder in a neurological emergency department. Methods: It is common that the initial approach to this patients include the use of various diagnostic exams. In this series we reviewed 94 patients that arrived a neurological emergency room in a 3 year period. Results: 72 patients were females (76%), and the initial presumptive diagnosis were: neurovascular syndrome in 36 patients (38.3%), convulsive disorder in 20 patients (21.28%), and conversive disorder in 8 patients (8.51%). 82 patients had motor symptoms and 61 sensitive symptoms. 88 patients (93%) required neuroimaging studies, 77 (81%) patients underwent through basic biochemical panels. Other tests performed were:electroencephalogram in 12 patients (12.77%), electromyography in 11 patients (11.7%), lumbar punction in 8 patients (8.04%) and regarding the medical consult in the care of these patients 11 were evaluated by 1 specialists, 35 (37.2%) by 2 different specialties, 42 (44.63%) patients required evaluation by 3, and 6 patients (6.38%) required evaluation by 4 different specialties. Conclusions: Based on this data, we conclude that conversion disorders require a lot of resources in the emergency room and that the similarities with neurological diseases demands a complete workup including expensive diagnostic tools. However, this patients can be discharged safely without requiring hospitalization.

Neurodevelopment in HIV Infected Children at Roosevelt’s Hospital Infectious Diseases Clinic, in Guatemala

Background: The infection with HIV has been related to neurological disorders that are very frequent, since this virus crosses the blood-brain barrier and enters the CNS, thus affecting its neurological development. About 50% - 90% of infected patients, with an average age of onset from 19 months to 3 years old may present some types of neurological alteration during the course of the disease. Currently in Guatemala, there are no researches that show changes in the neurodevelopment of patients infected with HIV. Objective: To identify neurodevelopment of pediatric patients infected with the HIV, taking into consideration clinical and epidemiological characteristics. Materials and Methods: Fifty-six patients, who were under 8 years and 6 months of age, that met the inclusion criteria (confirmed diagnosis of HIV), were evaluated through neurodevelopment test (Bayley Test and McCarthy’s Scale) during the months of May and June of 2016. Results: Within the neurodevelopment evaluation, it was discovered that between 36% and 54% of evaluated patients that were 3 years and 6 months to 8 years and 6 months old, presented alterations in more than one area of neurodevelopment, correlating it with studies performed in other countries with 30% - 70% of neurological affection. Conclusions-All infected patients have alterations in more than one area of neurodevelopment. The most affected areas of neurodevelopment were the verbal, numerical and cognitive areas.

Invasive Infections for Endemic Fungi in Pediatrics in Guatemala

Background: Invasive fungal infections are common opportunistic diseases in patients with AIDS, other conditions related to immunodeficiency and healthy infants. Most publications on this subject are related to industrialized countries, and in adult population, with limited data in Latin America (except for Brazil, Colombia, and Argentina), and especially in pediatric population. These patients present a variety of clinical manifestations representing a diagnostic and therapeutic challenge for the health system. Objective: The objective of the study is to describe the epidemiological and laboratory characteristics of children with invasive fungal infections in Guatemala. Methods: A review of the microbiology service database was carried out at Roosevelt Hospital in Guatemala. Positive cultures were taken from children under 15 years of age, in a period of seven years, from 2007 to 2014, with its corresponding medical history. Results: Finally, 23 isolates were documented but only 15 patients were included in the study with complete information;10 Histoplasma capsulatum cases, 4 Cryptococcus neoformans cases and 1 Coccidioidessp case. The average age was 7 years old for Histoplasma and 9 years old for Criptococo, with an age range from 6 months to 14 years. Around 60% of the patients were older than 5 years, of which, more than two-thirds were HIV positive children without antiretroviral therapy, who presented an invasive fungal infection at the time of HIV diagnosis. These infections are endemic in Guatemala, so the distribution was mostly uniform. Around 80% of the patients had some disease related to immunodeficiency and 70% were infected with human immunodeficiency virus (HIV). The microbiological isolation was from blood, bone marrow, lymph nodes, cerebrospinal fluid and urine. The predominant laboratory findings were decrease in hematological series. The most frequent clinical syndromes were fever, adenomegaly, hepatosplenomegaly, respiratory, gastrointestinal, neurological and weight loss. Mortality rate was 53% (from them, 62% were HIV positive). From these patients, an87% did not receive antifungal treatment in time due to late diagnosis of the infection. Conclusions: These infections should be considered when treating pediatric patients from tropical regions, with nonspecific systemic symptoms and signs, lymph node involvement and hematological alterations related to the mononuclear phagocytic system, mainly if they are patients infected by HIV in an advanced stage, infants, or children with a disease that weakens the immune system. When there is a high suspicion of a fungal infection, screening for HIV is mandatory;cultures should be taken early and together with rapid diagnostic tests. An antifungal treatment should be started immediately and then modified accordingly to laboratory results.

Stroke Due to Hypercoagulable State Can Mimic Multiple Sclerosis: A Case Report

Introduction: Stroke is the second major cause of mortality worldwide and in several cases, and it may lead to disability. Factor V Leiden is a common genetic thrombophilia, which causes activated protein C (APC) resistance. Hyperhomocysteinemia and factor V Leiden deficiency, two independent coagulopathy factors, can lead to venous and arterial infarctions in multiple small and large arteries and veins anywhere in the body. Case Report: Here, we report a unique case in which both hyperhomocysteinemia and factor V Leiden deficiency are documented together with MTHFR (C677T) (Methylene Tetra Hydro Folate Reductase) gene polymorphism and activated protein C resistance respectively. Conclusion: More interestingly, the mode of presentation in this case highly resembled that of progressive multiple sclerosis;all signs and symptoms slowly progressed without any systemic signs at first few years. Further studies needed to assess current outcomes.

Hemodialysis in Pregnant with Systemic Lupus Erythematosus: Case Report and Review

Systemic lupus erythematosus is an autoimmune disease with an etiopathogenesis that is still unclear. With a higher incidence in women of childbearing age. Pregnancy in patients suffering from this pathology is a constant challenge for multidisciplinary teams. The changes of pregnancy, especially to the immune system and the kidney, have repercussions on the renal compromise secondary to lupus. Lupus nephropathy is more active during pregnancy and leads to adverse outcomes for the mother-fetus binomial. The early identification of pregnant women with a higher risk of complications, access to health resources and the participation of a multidisciplinary team is the strategy that increases maternal-fetal survival. A report case of a 25-year-old black female with SLE and a 10-week pregnancy who was admitted to the emergency department with criteria for dialysis. The literature focused on lupus nephritis and dialysis in pregnancy was reviewed. Articles were reviewed in databases such as PubMed, Cochrane, among others, focused on the topic of pregnancy with SLE and pregnancy with dialysis. A total of 15 review articles, 2 meta-analyses, 3 observational studies and 6 cohort studies (3 prospective and 3 retrospective) were filtered.

Interdisciplinary feeding clinic during the coronavirus disease 2019 pandemic:Implementing telehealth and social determinants of health screening

Pediatric feeding disorders(PFD)are an impairment in oral intake that are associated with nutritional,medical,psychosocial,or feeding skills dysfunction.1 They are clinically complex and challenging due to the heterogeneous underlying etiologies and significantly impact health and social-emotional development.2 Furthermore.