In recent years, the number of cases of extrapulmonary tuberculosis in Iran has increased. The goal of this study was to determine the epidemiological status, clinical symptoms, diagnostic methods, and treatment strategies of extrapulmonary tuberculosis in Iran, with a focus on tuberculosis meningitis and miliary tuberculosis. Between January 1, 2000 and June 1, 2021, 1 651 cases of tuberculosis meningitis and miliary tuberculosis were discovered in Iran. The prevalence of tuberculosis meningitis was higher in Sistan and Baluchestan, South Khorasan, and Mazandaran compared with other provinces. The most prevalent symptoms of tuberculous meningitis were fever, anorexia, headache, neck stiffness, loss of consciousness, and vomiting. The most commonly used procedures for diagnosing tuberculous meningitis were polymerase chain reaction and cerebrospinal fluid culture. The most prevalent clinical symptoms of miliary tuberculosis were fever, lethargy, weariness, and anorexia. In 70% of chest radiographs, a miliary pattern was visible. Bone marrow biopsy was used to diagnose miliary tuberculosis in 80% of patients, while bronchoalveolar lavage was used in 20% of cases. The conventional 6-month treatment approach for tuberculous meningitis and miliary tuberculosis was used for all of the participants in the investigations. Given the high prevalence of extrapulmonary tuberculosis patients in Iran and the devastating consequences of the disease, the researchers recommend that further study be done to prevent extrapulmonary tuberculosis in the general population.

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Rationale: Dengue fever is a viral infection that is spread through the bites of infected female Aedes mosquitos. It can cause life threatening complications, including dengue haemorrhagic fever (DHF) and dengue shock syndrome. Patient concerns: A 15-year-old male presented with fever and petechiae and later developed hemoptysis. Diagnosis: Dengue fever with DHF with diffuse alveolar hemorrhage. Interventions: Invasive ventilation with high positive end expiratory pressure, multiple transfusions of packed red blood cells, fresh frozen plasma, single donor platelets and inotropic support Outcomes: The patient was stabilized and discharged on minimal supplemental oxygen. Lessons: Diffuse alveolar hemorrhage, although very rare, should be considered in a patient with dengue who presents with hemoptysis. The treatment is directed at providing respiratory and circulatory support, and preventing the progression of microcirculation damage.

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Objective: To describe the current reporting of pneumonia of unknown etiology (PUE) and factors that affect reporting by clinicians in China using the PUE surveillance system in order to provide a reference for improving PUE reporting rates in the future. Methods: Clinicians were recruited via the Sojump platform and requested to complete an anonymous self-administered questionnaire. Multivariate logistic regression analysis was used to assess factors influencing clinicians’ reporting activities. Results: This study showed a low PUE case reporting rate and a poor understanding of PUE reporting among the investigated clinicians. Of the 136 clinicians who had diagnosed PUE cases, multivariate logistic regression analysis results showed that clinicians who had attended in-hospital training were more likely to report PUE than those who had not (OR 4.48, 95% CI 1.49-13.46). Clinicians with an expert panel on PUE in their hospital were more likely to report PUE cases than those without (OR 5.46, 95% CI 1.85-16.11). Conclusions: There is a need to promote and reinforce PUE surveillance system training among medical staff. In addition, PUE testing technologies in hospital laboratories should be upgraded, especially in primary and unclassified hospitals, to increase surveillance efficiency and improve PUE reporting rates.

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Objective: To identify effects of various nationwide vaccination protocols on the evolution of new SARS-CoV-2 infections among adult population and to evaluate the safety of mRNA (BioNTech/ Pfizer) vaccine. Methods: Totally 10 735 adult volunteers that received at least one dose of BioNTech/Pfizer or triple doses of CoronaVac participated in this cross-sectional-online survey between 1 and 10 September 2021. The information was collected covering a 5-month period from April 2021 to September 2021. Information about people who were vaccinated with only single and double dose CoronaVac were not included in this study. Results: At least one side effect after single and double dose of BioNTech/Pfizer and triple doses of CoronaVac were observed in 42.1%, 42.5% and 10.9%, respectively. The most common side effects were shoulder/arm pain, weakness/fatigue, muscle/joint pain and headache. The side effects were the most frequent in single BioNTech/Pfizer, while it was the least in triple CoronaVac. The rate of positive PCR tests before vaccination was 17.6%, and decreased to 3.0% after vaccination. The rates of positive SARS CoV-2-PCR were 18.8%, 3.5%, 3.1%, 0.5% and 4.6% in single BioNTech/Pfizer, double BioNTech/Pfizer, double CoronaVac+single BioNTech/Pfizer, double CoronaVac+double BioNTech/Pfizer and triple CoronaVac, respectively. While 1.8% of PCR positive COVID-19 cases needed intensive unit care in the pre-vaccination period, intensive care unit was required in 0%, 1.5%, 2.4%, 0% and 4.2% after single BioNTech/ Pfizer, double BioNTech/Pfizer, double CoronaVac+single BioNTech/ Pfizer, double CoronaVac+double BioNTech/Pfizer and triple CoronaVac, respectively. Reinfection rate after vaccination was 0.4%. Conclusions: The rarity of COVID-19 infection after vaccination suggests that efficacy of vaccines is maintained. On the other hand, the data underscore the critical importance of continued public health mitigation.

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Objective: To assess the effectiveness of high-dose corticosteroid pulse therapy and evaluate possible factors associated with 28-day mortality in hospitalised patients with severe COVID-19 pneumonia. Methods: We conducted a single-centre retrospective cohort study on hospitalised patients with clinical, epidemiological, and/or radiologically confirmed and suspected COVID-19 at Bitlis Tatvan State Hospital in Turkey between December 1, 2020 and June 1, 2021. All data of the study participants were recorded, and all patients received intravenous high-dose corticosteroid pulse therapy. The Ordinal Scale for Clinical Improvement (OSCI), Charlson Comorbidity Index and Total Severity Score were calculated. Univariate and multivariate Cox regression models were performed to evaluate the clinical and laboratory parameters that may affect the 28-day mortality. Results: A total of 126 patients were included in the analysis. The 28-day mortality rate of the patients was 22.2%. Laboratory and clinical improvement were observed in 77.8% (98/126) of patients after high-dose corticosteroid pulse therapy. There was a statistically significant difference between the survivors and non-survivors in terms of age, platelet count, neutrophil/lymphocyte ratio, and OSCI, Charlson Comorbidity Index, and Total Severity Score (P<0.001). Multivariate Cox regression analysis revealed that age [HR 1.047 (95% CI 1.01-1.08)], use of prophylactic anticoagulation [HR 0.838 (95% CI 0.79-0.89)], and bacterial co-infection [HR 3.966 (95% CI 1.40-11.21)] were significant determinants of mortality. Early C-reactive protein (CRP) response, decreased oxygen requirement, and improving respiratory rate/OSCI scores after administration of high-dose corticosteroid pulse therapy could contribute to clinical improvement. Conclusions: CRP response, needed oxygen and OSCI scores can be used as prognostic factors to select patients who will benefit from high-dose corticosteroid pulse therapy.

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Rationale: Genitourinary tuberculosis can develop during the disease course of disseminated disease and the distinctive histological finding is epithelioid granuloma with or without caseation and accompanied Langhans-type giant cells. Barely, the lesion is only restricted to kidney involving both glomerular and extraglomerular compartment. Association with immune complex-mediated glomerulonephritis has been sparsely reported in the literature. Patient concern: A 42-year-old non-diabetic, non-hypertensive male presented with generalized body swelling and frothing of urine for 3 months. Diagnosis: Membranous nephropathy with tuberculous interstitial nephritis. Intervention: Anti-tuberculous therapy for extrapulmonary tuberculosis was administered along with low dose corticosteroid. Outcomes: Reduction of proteinuria was achieved at one month follow-up visit. Lessons: Tuberculosis should be considered as a potentially treatable cause of secondary membranous nephropathy as pharmacotherapy greatly helps improve the outcome.

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