Scan to discover online Background & Objective: A simple approach to prevent close contact in healthcare settings during the COVID-19 outbreak is to train patients to collect their own nasopharyngeal and oropharyngeal swabs and deliver them to medical laboratories to have them processed. The aim of our study was to compare lab technician-with patientcollected oropharyngeal and nasopharyngeal samples for detection of the coronavirus disease 2019 (COVID 19) using rapid real-time polymerase chain reaction (rRT-PCR). Methods: Fifty adult patients with flu-like symptoms and radiologic findings compatible with atypical pneumonia who were admitted to the infectious diseases ward of Imam Khomeini Hospital Complex, Tehran, Iran, with a clinical diagnosis of COVID-19 from February 28 to April 27 of 2020 were randomly selected and entered in our study. Two sets of naso-and oropharyngeal swabs were collected, one set by a lab technician and the other by the patients, and the COVID-19 rRT-PCR test was performed. Results: Of 50 selected cases, in seven patients all collected naso-and oropharyngeal swabs tested positive, and in 22 patients all samples tested negative for COVID-19 in rRT-PCR. Discrepancies between rRT-PCR results of lab technician-and patientcollected swabs were observed in 12 nasopharyngeal and 13 oropharyngeal specimens. Positive lab technician-collected and negative patient-collected samples were observed in 10 and 5 nasopharyngeal and oropharyngeal specimens, respectively. Negative lab technician-collected and positive patient-collected samples were observed in two and seven nasopharyngeal and oropharyngeal specimens, respectively. The overall percentage of agreement among both nasopharyngeal and oropharyngeal swabs taken by a lab technician and patients was 76% with a kappa value of 0.49 (P=0.001). Conclusion: Based on our findings, lab technician-collected naso-and oropharyngeal swabs cannot be replaced by patient-collected ones with regard to COVID-19 rRT-PCR.

Primary spinal hydatid cyst is considered as a very rare form of hydatid disease, which accounts for less than 0.5% to 1% of hydatid disease cases. Intramedullary hydatid cyst is extremely rare. Herein, the researchers reported on a 23-year-old male patient, who presented neck pain for 1.5 month and numbness of the right upper and lower extremities as well as ipsilateral disturbance in temperature sensation (Brown-Sequard syndrome) since two weeks prior to this hospital admission. Magnetic resonance imaging of cervical vertebrae revealed a 21 × 14 mm cystic intramedullary mass lesion with faint rim enhancement at C3 to C4 level with adjacent edema (Figure 1). Surgical resection was done and pathologic evaluation of the specimen was in favor of hydatid cyst disease, and the patient was treated with postoperative anthelmintic chemotherapy.

Background and Objectives: This prospective case-control study was conducted to evaluate abnormal serum protein electrophoresis (SPEP) patterns in patients living with human immunodeficiency virus (HIV) and its relation with disease severity markers and anti-retroviral treatment status. Materials and Methods: Thirty-seven HIV-positive patients and 24 healthy individuals were evaluated in the course of this study. The healthy HIV-negative individuals were selected as control group. Pregnant women, patients with malignancies, children, hepatitis B- and/or C-positive patients, those with a history of an autoimmune disease, or previous corticosteroid administration were excluded. SPEP—which detects serum levels of albumin, total protein, gammaglobulin—, CD4+ T-cell counts, viral load, and antiretroviral treatment status were assessed. Data were analyzed by SPSS™ software. Results: Twelve patients (32 percent) demonstrated polyclonal gammopathy on SPEP, while only 1 (4 percent) healthy individual had the same pattern (P-value = 0.007). No statistically significant connection between SPEP patterns and antiretroviral treatment status was observed (P-value > 0.05). Interestingly no statistically significant relationship between CD4+ T-cell counts and polyclonal gammopathy was discerned. No statistically significant difference was observed between the two groups with regards to serum albumin and total protein levels. The serum albumin to total protein percentage, serum gamma globulin to total protein percentage, and serum albumin to globulin ratio was compared between the groups and a statistically significant difference was observed. Conclusion: Polyclonal gammopathy on SPEP is common among HIV-infected patients. Moreover, the SPEP patterns cannot be used as an indication of a patient’s negative or positive response to treatment.

Glioblastoma (WHO grade IV) is the most common malignant tumor of neural tissues in adults as a primary tumor. Because of blood brain barrier and short median survival of patients with glioblastoma, metastasis of this tumor is very rare. A 46-year-old man was admitted to Sina hospital with chief complaint of headache and visual impairment. After neuro-radiologic evaluation the patient underwent surgery. Pathologic examination of the tumor confirmed the diagnosis of glioblastoma multiforme. Cytogenetic study of the tumor cells confirmed GBM IDH1 wild type with TERT mutation and EGFR amplification. Two months after surgical resection, the tumor recurred with involvement of the dura matter. After the second operation, metastasis to the pelvic cavity and cervical lymph node was found. Almost all cases of glioblastoma metastasis had undergone surgery or any manipulation; this fact suggests that iatrogenic intra-vascular seeding of tumor cells at the time of resection and disruption of blood brain barrier could cause extra-neural metastasis.