Shervin Shokouhi

Introduction: Brucella prosthetic joint infection is a rare condition. We report a case of bilateral prosthetic knee joint infection caused by Brucella melitensis, which was cured by prolonged antibiotic therapy without implant removal. Case Presentation: A 62-year-old woman was admitted to the Labbafinejad Hospital (Tehran, Iran), complaining of pain and swelling in her knee joints from two months ago. She was also suffering from intermittent fever and night sweats. She underwent bilateral total knee arthroplasty five years ago because of a severe degenerative joint disease. Agglutination tests (wright and 2-mercaptoethanol (2-ME)) were positive. Her knee joint fluid and blood cultures yielded B. melitensis. The polymerase chain reaction result from her knee joint fluid was positive for Brucella spp. The patient was cured after combination therapy with doxycycline, rifampin, and gentamicin. The prosthesis was retained due to the lack of loosening in radiography. Ten months after th...

Cryptococcal meningitis (CM), as a life-threatening opportunistic infection, often is among cases with cell-mediated immunodeficiencies, such as AIDS, hematologic malignancies, and solid organ transplant recipients. Cryptococcal meningitis in healthy individuals is uncommon, and its detection in immunocompetent cases may be tricky because the presentation is generally more indolent than the traditional meningitis presentation, leading to late diagnosis and potential sequels. We present a CM case in an immunocompetent Iranian male patient who was treated successfully.

To the editor, In the pandemic era of COVID-19 and its vaccines, patients on immunosuppressive medications need special considerations. Immunosuppression can disturb the effectiveness of the vaccine responses. Thus, establishing a proper recommendation for timing of vaccination in these patients would be challenging. The immunosuppressive effects of corticosteroids (CS) vary and depend on its duration of use and doses. Doses > 40 mg/day prednisone or equivalent for more than 1 week or ≥ 20 mg of prednisone or equivalent for 2 weeks or more induce immunosuppression. The current recommendations for COVID-19 vaccines and CS administration are mostly based on the available evidences for inactivated vaccines (e.g. influenza). Choosing the best time to increase the efficacy of vaccination is important in immunosuppressed patients. Also, each country’s vaccine policy is important to set out vaccination times in these specific groups. In some countries, especially developing countries, the COVID-19 vaccination schedule is not adjustable by the patients or physicians, and selecting a particular time window for the best efficacy of immunization is impossible. However, if the vaccination schedule is not adjustable, it is recommended to receive the vaccine without delay. If the schedules are adjustable, the following issues can be considered to improve the vaccine response: Evidence showed that with the dose of up to 20 mg/day prednisone or equivalents, the response to inactivated vaccines could not be suppressed, and these patients can receive vaccines safely. Patients treated with prednisone at a dose of less than 20 mg/day are not immunocompromised and have sufficient immune response. The immunosuppressive doses of CS are prednisone or equivalent ≥ 20 mg/day for ≥ 2 weeks, or > 40 mg prednisone or equivalent for > 1 week. The ideal time for vaccination in this group is 1 month after discontinuation of the CS treatment to elicit an adequate immune response. If it was not possible to end the CS treatment, it is better to prescribe the vaccine when receiving the lowest dose of CS. For example, the dose of CS can be reduced to less than 20mgwith or without the addition of steroids sparing drugs (e.g. azathioprine), and then at least 2 weeks after vaccination, the dose of the drug returns to the previous state. Suppose the patient is a candidate for CS therapy with doses of ≥ 20 mg prednisone for ≥ 2 weeks or > 40 mg prednisone for > 1 week. In this case, it is suggested that vaccine be administered at least 2 weeks before immunosuppression initiation because 2 weeks are required to develop an immune response. But if the CS administration cannot be withheld after vaccination because of disease flare or if the patient may not have access to the vaccine with the recommended interval, we suggest ordering the

Abstract In this study, the net analyte signal (NAS) and radial basis function neural network (RBF-NN) are presented for the simultaneous spectrophotometric analysis of metformin (MET) and sitagliptin (STG) in mixtures and tablet formulation. The coefficient of determination (R2) related to the test set of NAS procedure were achieved 0.9942 and 0.9853 for MET and STG, respectively. Also, mean recovery and root mean square error (RMSE) were found 99.66, 99.24% and 0.105, 1.116 for MET and STG, respectively. In the RBF-NN model, mean square error (MSE) with 23 epochs was 1.25 × 10−22 and 1.07 × 10−21 for MET and STG, respectively. Relative standard deviation (RSD) value was less than 1.5 in the analysis of the anti-diabetic tablet (Zipmet) for both approaches. The statistical comparison using analysis of variance (ANOVA) test proved that there was no significant difference between the proposed methods and the high-performance liquid chromatography (HPLC).

Introduction The effectiveness of umifenovir against COVID-19 is controversial; therefore, clinical trials are crucial to evaluate its efficacy. Methods The study was conducted as a single-center, randomized, open-label clinical trial. Eligible moderate-severe hospitalized patients with confirmed SARS-Cov-2 infection were randomly segregated into intervention and control groups. The intervention group were treated with lopinavir / ritonavir (400mg/100mg bid for 10-14 days)+ hydroxychloroquine (400mg single dose)+ interferon-β1a (Subcutaneous injections of 44µg (12,000 IU) on days 1, 3, 5) + umifenovir (200mg trice daily for 10 days), and the control group received lopinavir / ritonavir (same dose)+ hydroxychloroquine (same dose)+ interferon-β1a (same dose). Results Of 1180 patients with positive RT-PCRs and positive chest CT scans, 101 patients were finally included in the trial; 50 were assigned to receive IFNβ1a+ hydroxychloroquine+ lopinavir/ritonavir group and 51 were managed to treat with IFNβ1a+ hydroxychloroquine+ lopinavir/ritonavir + umifenovir. Since all patients received the intended treatment as scheduled, the analysis just included as the ITT population Time to clinical improvement (TTCI) did not hold a statistically significant difference between intervention and control groups (median, 9 days for intervention group versus 7 days for the control group; P: 0.22). Besides, Hazard Ratio for TTCI in the Cox regression model was 0.75 (95% CI: 0.45-1.23, P:0.25) which also confirmed that there was no statistically significant difference between the treatment group and the control group. The mortality was not statistically significant between the two groups (38% in controls vs 33.3% treatment group). Conclusions Our findings shed new lights on the facts that additional umifenovir has not been found to be effective in shortening the duration of SARS-CoV-2 in severe patients and improving the prognosis in non-ICU patients and mortality. Trial registration The trial was confirmed by the Ethics in Medical Research Committee of the Shahid Beheshti University of Medical Sciences. signed informed consents were obtained from all the participants or their legally authorized representatives. This trial has been registered as ClinicalTrials.gov, NCT04350684.

Background: Antimicrobial resistance of Streptococcus pneumoniae (S. pneumoniae) has shown major changes in recent years. On the other hand, macrolide antibiotics are being increasingly used in clinical practice. Several studies have reported increased resistance to this group of antibiotics, while there is no comprehensive information in this area. Accordingly, the present study was designed to estimate the resistance of S. pneumoniae to macrolides in Iran. Materials and Methods: In this review, articles (2000–2017), evaluating the level and type of S. pneumoniae resistance to macrolides in Iran, were extracted by searching different databases, and the results were analyzed. Results: A total of 25 relevant articles were retrieved and analyzed. Overall, 2723 cases had been recruited in these studies. The mean percentage of resistance to macrolides was estimated at 48.43% (CI, 38.8–57.9%). In the majority of reported cases, the resistance mechanisms included ribosomal methylation (i....

Abstract: Background: Pneumocystis pneumonia (PCP) incidence in acute myeloid leukemia (AML) patients have not been well described and some studies have shown the risk of this infection in these groups of patients. In this systematic review, we reviewed the published studies about PCP in AML to evaluate the PCP incidence and outcomes in these patients and then focuses on its immunological mechanism. Method: All articles reviewed in this collection are from recruited sites: PubMed and Embase databases. No time limit was considered for article searching. The following keywords were used: (“Pneumonia, Pneumocystis” OR Pneumocystis Pneumonia” OR “Pneumocystis jirovecii”), AND (“leukemia, myeloid, acute OR acute myeloid leukemia”). Our search strategy yielded 356 articles. After implementing the exclusion and inclusion criteria, the final papers were selected and reviewed. Result: By our search, 356 articles were found (316 in PubMed and 40 in Embase). After the implementation of inclusi...

Abstract In this study, the spectrophotometric method and intelligent chemometrics approaches, including artificial neural network (ANN) and least squares support vector machine (LS-SVM) were developed to determine metformin (MET) and sitagliptin (STG) in the pharmaceutical dosage form. Feed-forward backpropagation neural network (FFBP-NN) with Levenberg Marquart (LM) and conjugate gradient (SCG) algorithms was used. The results of ANN indicated that the LM algorithm with 3 layers and 6 neurons, as well as 5 layers and 8 neurons, had better performance with mean square error (MSE) of 9.12 × 10−29 and 3.56 × 10−29 for MET and STG, respectively. Also, layers 2 and 5 with the 8 neurons showed the least error for MET and STG in the scaled conjugate gradient (SCG) algorithm, respectively. Next, the least support vector machine method was used to estimate the mentioned components simultaneously. The regularization (γ) and width (σ) parameters of the LS-SVM method were optimized based on the leave-one-out (LOO) cross-validation method and the root mean square error (RMSE) of MET and STG were 0.4884 and 0.9336, respectively. Real pharmaceutical sample analysis was performed using the proposed methods and high-performance liquid chromatography (HPLC). One-way analysis of variance (ANOVA) test with a 95 % confidence level was applied to the results. Obtained statistical data from the comparison of the proposed methods with the reference technique showed no significant differences.

Background: Due to the characteristics of the low CRP and WBC count in acute pyelonephritis, Procalcitonin (PCT) measurement can be a useful and practical option in acute pyelonephritis. According to different results in the investigation of the diagnostic value of PCT; the aim of this study was to evaluate the diagnostic value of PCT in differentiation of the lower urinary tract infection from acute pyelonephritis. Methods: All patients with a diagnosis of urinary tract infection in Imam Reza and Sina hospitals were enrolled in this study. Positive urine culture was considered as a urinary tract infection. If urinary tract infection with a pathogen colony more than 10 5 or more than 10 4 colonies is marked in person, it was considered as a urinary tract infection. In all patients, leukocyte count, ESR, CRP, and serum PCT was measured. In all patients with febrile urinary tract infection, radioisotope scan was performed. If a parenchymal defect was found in scan, they were considere...

Microorganism isolation from respiratory tract specimens is the standard of care in patients with suspected nosocomial and ventilator associated pneumonia. However, these methods are time-consuming and are influenced by several factors. A direct quantitative smear (DQS) with proper staining may be an easy, cost-effective, rapid method. We evaluated the diagnostic yield of direct smears compared to semi-quantitative culture methods. Hospitalized, intubated patients with clinically suspected pneumonia and patients who underwent diagnostic bronchoscopic alveolar lavage (BAL) and trans-endotracheal aspiration (TEA) were enrolled in a prospective study. The obtained specimens were Gram stained and microorganisms were computed per 10 high-power fields (HPFs) of light microscopy. All samples were cultured by a standard semi-quantitative method. Colony-forming units (CFU) >104/mL and >105 CFU/mL were reported as culture-positive for BAL and TEA, respectively. A total of 331 respirator...

Infective endocarditis (IE) is a rare but serious disease with different clinical pictures. Its neurological complication is commonly mistaken in term of diagnosis and treatment. Therefore, such cases must be taken under further diagnostic imaging for searching the basic structural lesions. Known causes of these signs include cardio embolism with hemorrhagic transformation, septic embolism, or mycotic aneurysms. In this paper, our case was a patient admitted for the evaluation of local neurological complaint reason and subsequent therapy. He was found to have bacterial endocarditis after medical workup. It was diagnosed prospectively from positive tests of vegetation on Transesophageal echocardiogram and Magnetic resonance imaging (MRI) results.

We report the treatment and follow-up, including magnetic resonance imaging (MRI) of a patient with idiopathic hypertrophic pachymeningitis and review the literature published in 21th century, with emphasis on the management and clinical outcomes of this rare disorder. Hypertrophic pachymeningitis is extremely rare. It is a fibrosing inflammatory process which involves the dura mater. Numerous pathological entities produce thickening of the pachymeninges. Thus, idiopathic hypertrophic pachymeningitis is diagnosed by exclusion. We present a case of patient with idiopathic hypertrophic pachymeningitis who had varied clinical presentation. Imaging studies revealed diffuse thickening of the pachymeninges.

INTRODUCTION Nephrotoxicity has been a concern with new dosing regimens of colistin. This study was designed to compare nephrotoxicity of high dose and conventional dose of colistin and the ability of detecting it using neutrophil gelatinase-associated lipocalin (NGAL). MATERIALS AND METHODS A randomized clinical trial was carried out on 40 patients with multidrug-resistant gram-negative infections assigned into 2 groups to receive high and conventional doses of colistin. Blood samples were taken 4 times for measuring serum NGAL. The incidence of acute kidney injury was also evaluated based on the risk, injury, failure, loss, end-stage renal disease (RIFLE) criteria. RESULTS Baseline levels of NGAL were not significantly different between the patients on the high dose and conventional dose of colistin. The mean NGAL levels on day 10 were 762.14 ± 415.44 pg/mL and 623.67 ± 272.61 pg/mL, respectively.  However, between-group analysis did not show a significant difference in the NGAL l...

Infective endocarditis (IE) is a rare but serious disease with different clinical pictures. Its neurological complication is commonly mistaken in term of diagnosis and treatment. Therefore, such cases must be taken under further diagnostic imaging for searching the basic structural lesions. Known causes of these signs include cardio embolism with hemorrhagic transformation, septic embolism, or mycotic aneurysms. In this paper, our case was a patient admitted for the evaluation of local neurological complaint reason and subsequent therapy. He was found to have bacterial endocarditis after medical workup. It was diagnosed prospectively from positive tests of vegetation on Transesophageal echocardiogram and Magnetic resonance imaging (MRI) results.

Background: Interferons are essential part of the innate immune and have antiviral and immunomodulatory functions. In the lack of definite medication for COVID-19, Interferons can be effective in treatment of severe cases of COVID-19 and may decrease mortality of this disease.Material and methods: This retrospective study was conducted on hospitalized COVID-19 patients in Loghman-Hakim hospital from 20 February 2020 to 20 April 2020, Tehran, Iran. Patients were selected from two groups, first group received Interferon β-1a in addition to standard treatment regimen and patients of second group received standard care. The clinical progression of two groups during their hospital admission have been compared.Results: We studied total number of 395 hospitalized COVID-19 patients. Out of this number, 111 patients (33.5%) died (31.3% of Interferon β-1a (Recigen) group and 34.1% of control group). Mortality rate indicated no statistically significant difference between groups, however for p...

Nephrotoxicity has been a major long-standing concern about colistin.This study was designed to compare nephrotoxicity of high dose and conventional dose of colistin. A randomized open-labeled clinical trial on 40 patients with multi-drug resistant gram negative infections was designed. Patients were allocated into two equal-size groups receiving high (a loading dose of 9 million international units (MIU) and maintenance doses of 4.5 MIU every 12 h) and conventional dose (2 MIU every 8 h) of colistin. Blood samples were taken on day 1, 3, 5, 7 and 10 of treatment for measuring serum cystatin C (Cys C) levels. Incidence of acute kidney injury (AKI) was also evaluated based on RIFLE criteria. Mean ± sd of the difference between baseline and day 10 Cys C levels in high dose and conventional dose groups were 1.61 ± 0.90 and 1.32 ± 0.48, respectively (P = 0.30). Within group analysis showed increase in Cys C levels in both groups (P = 0.001),however, no significant difference in Cys C le...

Penicillium notatum is a fungus that widely exists in the environment and is often non-pathogenic to humans. However, in immunocompromised hosts it may be recognized as a cause of systemic mycosis. A 44-year-old man with acute myeloid leukemia (AML) was admitted to our hospital with fever and neutropenia. Due to no improvement after initial treatment, he underwent bronchoscopy. The patient was found to have P. notatum and Pneumocystis jiroveci infection, and therefore was given voriconazole, primaquine and clindamycin. The patient was successfully treated and suffered no complications. Conclusion: This case highlights P. notatum as a cause of infection in immunocompromised patients. To the best of our knowledge, mixed lung infection with P. notatum and P. jiroveci in a patient with AML has not been previously reported.

Background: Mycobacterium tuberculosis is the cause of 43% of the peripheral lymphadenopathy cases in developing countries. However, psoas abscesses are usually secondary to the extension of infection from an adjacent site. In the present study, we describe a case of abdominal and cervical lymphadenopathy and multiple abscesses due to mycobacterium tuberculosis. Patient: A 55 years old man with abdominal and cervical lymphadenopathy, psoas muscle sheath abscess and a large abscess of abdominal wall was admitted. Vertebral column was intact and the patient didn’t have immunodeficiency or history of illicit drug use. Analysis of aspirated pus with PCR for mycobacterium tuberculosis was positive, however, Ziehl-Neelsen and gram staining was negative. Culture of pus was positive for mycobacterium. Treatment was commenced with 4 drug antituberculosis regimen. During the treatment period, paradoxical reaction occurred and prednisolone was administered. Following 9 months of treatment, the...

Ventilator-associated pneumonia (VAP) is a common and serious problem that develops after more than 48 h of mechanical ventilation. Improving the activity of immune system with vitamin D, and its consequent impact on prognostic biomarkers of VAP was studied in the current study. A randomized double blind placebo controlled clinical trial was designed. A total of 46 patients with VAP, who were suffering from vitamin D deficiency, were randomly allocated into the study groups of placebo (n=22) and treatment (n=24) The treatment group received 300,000 units of intramuscular vitamin D. Serum levels of procalcitonin and vitamin D along with SOFA and CPIS scores were determined at baseline and on day 7 after intervention. The mortality rate of patients was also monitored for the succeeding 28 days after the injection. The administration of vitamin D significantly enhanced its levels (P<0.0001) in the treated patients (12.28 ± 8.26) in comparison to placebo group (1.15 ± 1.50). The leve...

Methods: This study was conducted as a descriptive study on 100 isolates of P. aeruginosa isolated from patients hospitalized in Shahid Motahari Hospital during 2014-2015. Antibiogram tests were performed using disc diffusion (according to CLSI guidelines). The inhibitory effect of carbonyl cyanide 3-chlorophenylhydrazone (CCCP), was assessed by broth microdilution method. Mutation in mexA and mexB genes, was detected by PCR and sequencing, and the expression level of mexA gene, was evaluated by real-time PCR and 2 −ΔΔCT formula.

Background: Primary and secondary infections and malignancies are inflammatory causes of fluid accumulation in the pleural space. TB is one of the infective causes of pleural effusion and is similar to malignancies because of its subacute and chronic process; although their management is extremely different. CA-125 is a glycoprotein tumor marker with molecular weight of 200 KD, which is found on the surface of ovarian and some normal and inflammatory cells. In both malignancy and tuberculosis, this tumor marker increases in serum and consequently in pleural fluid. This study was conducted to evaluate and compare CA-125 tumor marker in pleural effusion resulting from malignancies and tuberculosis. Materials and Methods: twenty-seven TB patients (18 men and 9 women), with the mean (±SD) age of 37.3±13.9 yrs. and 23 patients affected by malignant tumors (16 men and 7 women) with the mean (±SD) age of 57.9±17.7 yrs. were evaluated during 2004-2005. In malignant cases, diagnosis was made...

Poor penetration of vancomycin into Central Nervous System (CNS) can lead to treatment failure. The aim of this study was to evaluate and compare CSF concentration and serum pharmacokinetics of high dose vancomycin by continuous infusion vs. intermittent infusion in post neurosurgical meningitis patients. Twenty patients were divided into two groups. Patients in intermittent infusion group received vancomycin as a loading dose of 25 mg/kg over two hours, followed by 25 mg/kg over two hours every 12 h. In the Continuous Infusion group, patients received vancomycin as a loading dose of 25 mg/kg over two hours, followed by 50 mg/kg/day by continuous infusion. In the intermittent infusion group, mean ± SD of serum trough, peak and CSF concentrations were 17.49 ± 2.46 mg/L, 41.33 ± 2.73 mg/L, and 4.83 ± 1.05 mg/L, respectively. Mean of CSF/trough% ratio was 27.39 ± 2.43%. A positive linear correlation was found between the serum trough levels and CSF levels (r = 0.970, P < 0.001). In ...

Introduction The coronavirus disease 2019 (COVID-19) pandemic has caused significant mortality worldwide. The disease attacks the lung tissue and may lead to acute respiratory distress syndrome. An in vitro study showed that hydroxychloroquine (HCQ) has a prophylactic effect against COVID-19 due to its anti-inflammatory effects. The present study aimed to evaluate the prophylactic effect of HCQ on individuals in close contact with patients with COVID-19. Method In this quasi-trial study, we prescribed HCQ for 7 days to all people who had close contact with a patient with COVID-19. All contacts underwent a nasal swab in two steps, and those positive for COVID-19 were excluded from the study. After 14 days of follow-up, the clinical and laboratory manifestations of COVID-19 were evaluated. Results A total of 113 participants completed the study. The HCQ group comprised 51 (45.13 %) contacts, and 62 (54.86 %) contacts were allocated to the control group. According to the results of clinical examination and real-time polymerase chain reaction test, 8 (12.90%) contacts in the control group were reported to have contracted COVID-19. In the HCQ group, 7 (13.72%) contacts were confirmed to have contracted COVID-19. There was no relationship between HCQ use and age, sex, underlying disorders, and laboratory data (all p >0.05). In terms of HCQ side effects, five participants experienced gastrointestinal and cutaneous side effects that subsided on discontinuation of HCQ. Conclusion The current study showed that HCQ had no prophylactic effect with regard to COVID-19 prevention.

Background: The combination of sofosbuvir (SOF) and daclatasvir (DCV) has shown preliminary efficacy for patients with COVID-19 in five open-label studies with small sample sizes. This larger trial aimed to assess if the addition of sofosbuvir and daclatasvir to standard care improved clinical endpoints in hospitalized patients with moderate or severe COVID-19.  Methods: This was a placebo-controlled, randomized clinical trial in adults with moderate or severe COVID-19 admitted to 19 hospitals in Iran. Patients were randomized to SOF/DCV 400/60mg once-daily or placebo in addition to standard of care. Patients were included if they had positive PCR or diagnostic chest CT, O 2 saturation <95%, and compatible symptoms. The primary endpoint was discharge from hospital within 10 days of first treatment. The trial is registered on Iran Registry of Clinical Trials under IRCT20200624047908N1 available at https://www.irct.ir/trial/49198. Results: Between July and October 2020, 1083 patients were allocated to either the SOF/DCV treatment arm (n=541) or matching placebo (n=542). The primary endpoint was achieved by 358 / 541 (66%) in the SOF/DCV arm and 370 /542 (68%) in controls (relative risk = 0.97, 95% CI = 0.89-1.05). The in-hospital death rates were 58/541 (11%) in the SOF/DCV group versus 53/542 (10%) in the placebo group (relative risk = 1.1, 95% CI = 0.77 to 1.56).  Conclusions: We observed no significant effect of SOF/DCV versus placebo on the rate of hospital discharge or survival in hospitalized COVID-19 patients. However, the patient population was generally severe cases that may have been too advanced for antiviral drugs to be effective.  Trial Registration: Iran Registry of Clinical Trials under IRCT20200624047908N1 available at https://www.irct.ir/trial/49198. Funding: This trial was sponsored by Abadan University of Medical Sciences and funded by the International Treatment Preparedness Coalition (grant number ITPC-2020) Declaration of Interests: S.Merat has received travel grants from and is a stockholder of Fanavaran Rojan Mohaghegh Daru Co. ANB and HNB are stockholders of Fanavaran Rojan Mohaghegh Daru Co. All other authors: none to declare. Ethics Approval Statement: The study protocol has been approved by the Abadan Faculty of Medicine Sciences Institutional Review Board and the Iranian Registry of Clinical Trials (IRCT) registry team.

Abstract Background Botulism is a rare but serious disease, which appears in different forms. In this study, we reviewed the clinical features, laboratory data, and outcomes of patients who referred to our tertiary center. Materials and methods All confirmed cases of botulism referred to an academic referral center and a teaching hospital during 2009–2019, were retrospectively reviewed. Results Fifty-three cases of clinical or laboratory-confirmed botulism were examined in this study. Nineteen patients were confirmed by laboratory data (serotype A (89.5%) and serotype E (10.5%)). In seven cases, the cause of botulism was unclear. In two patients, systemic symptoms emerged after the therapeutic injection of botulinum neurotoxin. The majority of cases (83%) were caused by an obvious food source. In 66% of cases, the initial symptoms emerged within less than 36 h, while in 20.8% of cases, the symptoms developed within or after 36 h; however, in seven patients that their botulism sources were unclear, the onset could not be estimated. All patients showed cranial involvement and generalized manifestation, and 49.1% had gastrointestinal symptoms. Except for two patients who were not treated due to immediate drug reactions who manifested severe hemodynamic instability, the rest of the patients were treated with trivalent antitoxin (A, B, and E). The complete resolution of the symptoms during hospitalization was documented in 50.9% of the patients. About 17% of the patients were intubated. Two patients died due to massive bilateral pulmonary thromboembolism and cardiac asystole following respiratory failure. Conclusions Although the complete resolution of the symptoms usually takes several weeks, in our experience, most patients showed at least partial resolution upon discharge. Early treatment results in better outcomes.

Acinetobacter baumannii is an opportunistic bacterial pathogen predominantly associated with hospital-acquired infections. Here we present a case of infective endocarditis of native Mitral and Aorta valves caused by A. baumannii in a 73-year-old man. He underwent surgical excision and Pathologic specimen showed A. baumannii growth after 48 hours that was exten- sively drug-resistant (XDR). He was treated with colistin and tigecycline. Finally, he discharged with no important compli- cation. To our best knowledge, it is the first case of Acinetobacter endocarditis has ever been reported in Iran. Although XDR A. baumannii is a life-threatening pathogen, proper and timely treatment can be life-saving.

We present a case of acute meningitis due to extended-spectrum beta-lactamase-producing E. coli in a patient with immune thrombocytopenic purpura and diabetes mellitus. This challenging entity is uncommon but has a high mortality rate. The exact mechanism for the pathogenesis is not obvious and needs further studies

Type 1 Interferons (IFNs) have been associated with positive effects on Coronaviruses. Previous studies point towards the superior potency of IFNβ compared to IFNα against viral infections. We conducted a three-armed, individually-randomized, open-label, controlled trial of IFNβ1a and IFNβ1b, comparing them against each other and a control group. Patients were randomly assigned in a 1:1:1 ratio to IFNβ1a (subcutaneous injections of 12,000 IU on days 1, 3, 6), IFNβ1b (subcutaneous injections of 8,000,000 IU on days 1, 3, 6), or the control group. All three arms orally received Lopinavir/Ritonavir (400 mg/100 mg twice a day for ten days) and a single dose of Hydroxychloroquine 400 mg on the first day. Our utilized primary outcome measure was Time To Clinical Improvement (TTCI) defined as the time from enrollment to discharge or a decline of two steps on the clinical seven-step ordinal scale, whichsoever came first. A total of 60 severely ill patients with positive RT-PCR and Chest CT ...

Introduction: As diabetes is highly prevalent worldwide, understanding particular dimensions of COVID-19 infection in diabetic patients is of significant importance. Objectives: The present research aimed to evaluate the outcome of diabetic patients with COVID-19 infection, and the clinical and biochemical characteristics in survived and non-survived patients. Patients and Methods: The present single-center, cross-sectional study examined laboratory and clinical features of 160 patients with diabetes who had moderate to severe criteria. The obtained data were categorized as survived or non-survived patients and then we compared the clinical characteristics in two groups. Results: In this study, 160 diabetic patients (75 men and 85 women) admitted with moderate to severe Covid-19 were evaluated. The mean age of studied patients was 51-90 years old, with diabetes duration of 5 to 15 years. One hundred thirty-one patients (81.9%) survived, but twenty-nine patients (18.1%) did not survi...

IntroductionIn critically ill COVID-19 patients, uncontrolled over-production of inflammatory mediators is observed, dominantly. The excessive immune response give rise to multiple organ dysfunction. Implementing extracorporeal therapies may be useful in omitting inflammatory mediators and supporting different organ systems. We aimed to investigate the effectiveness of hemoperfusion in combination with standard therapy in critically ill COVID-19 patients.MethodWe conducted a single-center, matched control retrospective study on patients with confirmed SARS-CoV-2 infection. Patients were treated with hemoperfusion in combination with standard therapy (hemoperfusion group) or standard treatment (matched group). Hemoperfusion or hemoperfusion and CRRT (continuous renal replacement therapy) therapies were initiated in hemoperfusion group. The patients in the matched group were matched one by one with the hemoperfusion group for age, sex, the oxygen saturation (SPO2) at the admission and...

Background: Brucellosis is an important zoonotic disease with numerous manifestations. The immune response induced by Brucella differs from those caused by other intracellular bacteria. To the best of our knowledge, the behavior of Brucella in patients with different cancers has not been reviewed. The present study aimed to evaluate brucellosis in this group of patients.Methods: All cases of brucellosis in patients with neoplastic disorders were searched in PubMed, Google Scholar, Scopus, and Web of Science and retrieved from the relevant articles. The search was performed without time, language and age limitations and using keywords such as brucellosis, Brucella, cancer, neoplasm, malignancy, and chemotherapy. All clinical features, types of neoplasm, diagnoses, and treatment timings of neoplasms and brucellosis, as well as patient outcomes, were searched.Results: Thirty-two eligible cases were extracted from 28 articles. The patients had a broad age range. Constitutional symptoms ...

Introduction: Coronavirus disease 2019 (COVID-19) has been a serious obstacle in front of public health. Interferon-beta 1a (IFN-β 1a) has been used to treat patients with COVID-19. We aimed to compare the effectiveness of high dose IFN-β 1a compared to low dose IFN-β 1a (the base therapeutic regimen) in moderate to severe COVID-19 cases.Methods: In this randomized, controlled, and clinical trial, eligible patients with confirmed SARS-CoV-2 infections were randomly assigned to receive one of the two following therapeutic regimens: The intervention group was treated with high dose IFN-β 1a (Recigen) (Subcutaneous injections of 88μg (24,000 IU) on days 1, 3, 6) + lopinavir /ritonavir (Kaletra) and the control group was treated with low dose IFN-β 1a (Recigen) (Subcutaneous injections of 44μg (12,000 IU) on days 1, 3, 6) + lopinavir /ritonavir (Kaletra) (400mg/100 mg twice a day for 10 days, orally, in all two groups). Result:A total of 168 COVID- 19 confirmed patients underwent random...

Objectives We will investigate the effectiveness of high dose Interferon Beta 1a, compared to low dose Interferon Beta 1a (the base therapeutic regimen) in COVID-19 Confirmed Cases (Either RT-PCR or CT Scan Confirmed) with moderate to severe disease Trial Design This is a single center, open label, randomized, controlled, 2-arm parallel group (1:1 ratio), clinical trial. Participants The eligibility criteria in this study is: age ≥ 18 years, oxygen saturation (SPO2) ≤ 93% or respiratory rate ≥ 24, at least one of the following manifestation: radiation contactless body temperature ≥37.8, Cough, shortness of breath, nasal congestion/ discharge, myalgia/arthralgia, diarrhea/vomiting, headache or fatigue on admission. The onset of the symptoms should be acute (≤ 14 days). The exclusion criteria include refusal to participate, using drugs with potential interaction with lopinavir/ritonavir or interferon-β 1a, blood ALT/AST levels > 5 times the upper limit of normal on laboratory resul...

Objectives We will investigate the effectiveness of Interferon Beta 1a, compared to Interferon Beta 1b and the usual therapeutic regimen in COVID-19 in patients that have tested positive and are moderately to severely ill. Trial design This is a single center, open label, randomized, controlled, parallel group, clinical trial that will be conducted at Loghman Hakim Medical Education Center in conjunction with Shahid Beheshti University of Medical Sciences. Participants Sixty COVID-19 confirmed cases (using the RT-PCR test) will be enrolled in the trial between April 9th to April 14th 2020. Patients will be randomly assigned to the intervention groups or the control group with the following eligibility criteria: ≥ 18 years of age AND (oxygen saturation (SPO2) ≤ 93% OR respiratory rate ≥ 24) AND at least one of the following: Contactless infrared forehead thermometer temperature of ≥37.8, cough, sputum production, nasal discharge, myalgia, headache or fatigue on admission, and time of...