A systematic review and meta-analysis on the epidemiology,casual agents and demographic characteristics of onychomycosis in Iran

Onychomycosis or fungal nail infection is one of the most common fungal infections. Nearly 50% of all nail disorders are caused by fungi. This systematic review and meta-analysis was conducted to determine the prevalence of onychomycosis across Iran. We searched English and Persian databases for studies reporting the epidemiologic features of onychomycosis in Iranian people from January 2000 to December 2018. Literature search revealed 307 studies, of which 24 studies met the eligibility criteria. In order to identifying the existence of publication bias among studies, funnel plots were used. The results of the meta-analysis were visualized as a forest plot representing the prevalence estimates of each study. Heterogeneity was also analyzed using the I², Chi², and Tau² statistics. A high level of I² and Chi² was obtained among studies, which provides evidence of notable heterogeneity between studies. The results of current study revealed that the highest prevalence of onychomycosis was related to Mazandaran and Tehran provinces, respectively. As in the literature hypothesized shift in etiologic agents from yeasts to dermatophytes or molds could not be confirmed. Females were affected more frequently than males and in both sexes the highest incidence of infection occurrence was at the ages of > 50 years. It seems the highest prevalence of onychomycosis in Mazandaran and Tehran provinces is due to the concentration of specialist doctors and research centers in these two provinces compared with others which leads to more detection and more care of the disease. Therefore, further educational strategies in order to accurate diagnosis in other provinces is necessary to reduce the risk of onychomycosis in Iran.     

Recent Advances in the Diagnosis and Management of Ebola Virus Disease

Outbreaks of Ebola virus, a causative agent of hemorrhagic fever, in West Africa and the Democratic Republic of the Congo have highlighted the need for assays that can rapidly identify individuals infected with Ebola virus. These assays need to accurately detect and rule-out Ebola virus disease (EVD) and, ideally, not require advanced laboratory techniques. Over the course of the most recent outbreaks, field studies have evaluated the performance of rapid antigen and automated molecular tests, many of which were given emergency use authorization by the Food and Drug Administration. Overall, molecular assays demonstrated high sensitivity, while antigen testing had the highest sensitivity when the viral load was high. Specificity was high across the evaluated test options. In addition to the evaluation of diagnostic test methods, newly developed treatment options and the efficacy of ring vaccination to prevent disease transmission have been investigated. Findings from these field studies have demonstrated that many of the newly developed diagnostic assays, as well as experimental treatments and vaccination, are promising tools for controlling EVD.     

Optimal use of Rapid Diagnostics in Infection Control and Prevention

Clinical laboratories have implemented rapid diagnostic tests (RDTs) for the identification of bacterial pathogens, with subsequent improvements in antimicrobial stewardship, but these tests may also have a role in infection prevention. Early identification of pathogens by RDTs should allow faster implementation of infection prevention strategies with the goal of reducing transmission. In this review, we assess the use of RDTs as an infection control tool by exploring their role in screening, as well as diagnosis, of methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant gram-negative organisms, Clostridium difficile, and Mycobacterium tuberculosis. This assessment highlights the fact that implementation of RDTs to improve infection prevention will require ongoing collaboration between clinical laboratory personnel, infection prevention departments, and clinicians.     

The morphology and distribution of CD1a positive Langerhans cells in normal and squamous cell carcinoma of cervix

Introduction

Langerhans cells (LCs), a type of dendritic cells are the professional antigen presenting cells present in the mucosa surfaces. They play an important role in antitumor immune response. The present study aims to find out the morphology and distribution of CD1a positive LCs in normal and squamous cell carcinoma of cervix.

Allergic fungal rhinosinusitis caused by Neoscytalidium dimidiatum: A case report: Allergic fungal rhinosinusitis due to Neoscytalidium dimidiatum

Neoscytalidium dimidiatum is a rare dematiaceous fungus that was first described in 1916 as Dothiorella mangiferae. From the standpoint of epidemiology and therapy, early detection of fungal rhinosinusitis (FRS), the causative agents, and their associated risk factors can improve the therapeutic outcome and decrease the mortality rates among patients. In this study, we report a 34-year-old Iranian female patient with allergic bronchopulmonary aspergillosis (ABPA), who presented to our facility with an 8-year history of chronic fungal sinusitis, drug-resistant asthma, pneumonia, bronchitis, post-nasal discharge, nasal obstruction, nasal polyposis, and anemia. The patient was subjected to diagnostic nasal endoscopy and computed tomography (CT) scan of paranasal sinuses, as well as routine, complementary mycological, and molecular methods, which confirmed the diagnosis of allergic fungal rhinosinusitis in patients with ABPA. Neoscytalidium dimidiatum was isolated from the sinus of the patient. Results of in vitro susceptibility tests indicated that the case isolate was susceptible to amphotericin B and itraconazole at concentrations which are commonly achieved in patients receiving recommended dosages for invasive mycoses (0.25 to 0.75 mg/kg of body weight daily for amphotericin B and 100 to 400 mg daily for itraconazole) and resistant in vitro to caspofungin, voriconazole, and posaconazole. The patient was successfully treated with amphotericin B / itraconazole + postoperative oral corticosteroids (OCS). Neoscytalidium dimidiatum infection should be considered as a possible additional factor in the etiology of AFRS, especially in immunocompromised patients.