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We describe a 50‐year‐old woman who was recently diagnosed with tuberculosis, with acute alteration in mental status. EEG showed nonconvulsive status epilepticus features. Brain MRI revealed multiple ring‐enhancing lesions. She responded well to treatment for both status epilepticus and tuberculosis. Her level of consciousness improved and she became fully aware. Particularly in developing countries, Tuberculous meningitis is a very serious condition with a range of clinical presentations. It is important to consider nonconvulsive status epilepticus as one of its various presentation types, since timely intervention can be life‐saving.

Streptococcus pneumoniae is associated with high morbidity and mortality in the world. Commercially licensed and available pneumococcal conjugate vaccines (PCVs) contain 10 (PCV10) and 13 (PCV13) pneumococcal serotypes. The most common serotypes of S. pneumoniae causing clinical diseases and carriers of S. pneumoniae in Iran are not yet known. Reviewing and reporting trends in the distribution of pneumococcal serotypes in Iran will be useful for policy-making as PCV is being introduced into Iran’s routine immunization program. Here, we report a systematic literature review of studies regarding S. pneumoniae serotype distribution in clinical and carrier patients in Iran. MEDLINE (via PubMed), Scopus, Embase, Ovid, Google Scholar, Web of Science, and the Iranian Database were used to identify relevant papers published from 1 January 2000 to 21 August 2019. The search returned 8 relevant articles. Among serotypes causing invasive pneumococcal diseases (IPD), serotype 23F (16.4%) was the most circulating serotype followed by 19F (15.2%), 19A (11.3%), 6A/B (9.2%), 9 V (5.8%), and 11A (5.14%). In carrier patients, the most common serotypes were, in rank order, 6A/B (10%), 19F (9%), 14(6.2%), 17F (4.8%), and 20(4.5%). Vaccine coverage among IPD patients would be 67.1% for PCV10-TT and 73.8% for PCV13. The present review demonstrates that the serotypes which were most responsible for disease in Iran are included in PCV10-TT and PCV13. However, sentinel surveillance must be continued in representative parts of the country to assess changing trends in the distribution of pneumococcal serotypes and their implications for vaccine selection and rollout in Iran.

A correction to this paper has been published: https://doi.org/10.1007/s10096-020-04084-3.

Background. Regulation of the immune system is critical for fighting against viral infections. Both suppression and hyperactivity of the immune system result in failure of treatment. The present study was designed to show the effects of immune system-related medications on mortality and length of stay (LOS) in a cohort of Iranian patients with coronavirus disease 2019 (COVID-19). Methods. A data mining study was performed on 6417 cases of COVID-19 covered by 17 educational hospitals of Iran University of Medical Sciences, Tehran. Association of a researcher-designed drug list with death and LOS was studied. For death outcome, logistic regression was used reporting odds ratio (OR) with 95% confidence interval (CI). For LOS, right censored Poisson regression was used reporting incidence rate ratio (IRR) with 95% CI. Results. Among the corticosteroids, prednisolone was a risk factor on death (OR=1.41, 95%CI=1.03−1.94). This association was increased after adjustment of age interactions (OR=3.45, 95%CI=1.01−11.81) and was removed after adjustment of ICU admission interactions (OR=2.64, 95%CI=0.70−9.92). Hydroxychloroquine showed a protecting effect on death (OR=0.735, 95%CI=0.627−0.862); however, this association was removed after adjustment of age interactions (OR=0.76, 95%CI=0.41−1.40). Among the antivirals, oseltamivir showed a protecting effect on death (OR=0.628, 95%CI=0.451−0.873); however, this association was removed after adjustment of age interactions (OR=0.45, 95%CI=0.11−1.82). For reduction of LOS, the only significant association was for hydroxychloroquine (IRR=0.85, 95%CI=0.79−0.92). Conclusion. The results of such data mining studies can be used in clinics until completing the evidence. Hydroxychloroquine may reduce mortality in some specific groups; however, its association may be confounded by some latent variables and unknown interactions. Administration of corticosteroids should be based on the conditions of each case.

Background & objective Cutaneous vasculitis has different clinical manifestations. It may be idiopathic or associated with infections, medications, etc.Skin is involved in both small vessel vasculitis (SVV) and medium vascular vasculitis.We aimed to evaluate clinical signs, laboratory and pathological changes of cutaneous vasculitis among Iranian people. Material & methods This study was a descriptive study performed on 74 patients with cutaneous vasculitis from March 2011 to February 2019. Information includes histopathological data, as well as clinical variables including the age of onset, sex, area of involvement, type of lesion, symptoms, and diagnosis. Pathological and laboratory changes were collected and recorded as well. Results Of the 74 patients studied, hypersensitivity vasculitis 52(70%) was the most common form.Most of the patients had lower extremities involvement. The most common clinical features and symptoms were petechiae or purpura and itching. Fever, limb edema, and arthralgia were the most common symptoms, occurring in 26%, 20%, and 18% of patients, respectively. Among patients, 18 (24%) had taken medication before the lesions, 10 (13%) had vasculitis due to infection, and 44 (59%) were diagnosed as idiopathic form. The most common treatment was prednisolone in 69 patients (93%) with a mean dose of 15.6 ± 35 mg. Conclusion The study would be useful in understanding the various specific and non specific features of cutaneous vasculitis, helping the clinician to manage the condition.

Introduction.Contrast-induced Acute Kidney Injury (CI-AKI) is a prevalent complication of chronic kidney disease (CKD) patients. The aim of this study was to evaluate the effects of periprocedural administration of trimetazidine as an anti-oxidant agent on the incidence of CI-AKI in CKD patients based on changes of Neutrophil Gelatinase-Associated Lipocalin (uNGAL) level, which has recently been introduced as an early predictor of CI-AKI.Methods.One hundred CKD patients with a mean GFR of 50 ± 7 cc/min who were candidate for coronary angiography assigned randomly to receive (50 patients, intervention group) or not receive (50 patients, control group) trimetazidine (70mg/d) for 72 hours. CI-AKI was defined as 0.5 mg or 25% increase in serum creatinine. We also checked uNGAL before and 12h after angiography.Results.Serum creatinine, showed a trend of less increment in the case group, although could not achieve a significant difference, there was a significant difference in urinary NGAL rise between two groups. CI-AKI was defined as 1.7 times increase in uNGAL level (12h after angiography to pre-procedurally uNGAL level ratio) according to the ROC curves. The incidence of CI-AKI according to urinary NGAL definition was 8% in the Trimetazidine group and 24% in the control group (P< .05).Conclusion.We concluded that Trimetazidine treatment before angiography may be effective in CI-AKI prevention. Moreover, it is shown that 1.7 times increase in urine NGAL after angiography is a valuable cut off point for clinicians to discriminate high risk patients for contrast nephropathy.