alireza adibimehr

 Invasive fungal infections (IFIs) are a significant cause of mortality and morbidity in patients with hematological malignancies. Given the considerable prevalence and consequences of IFIs, hence revealing the exact cause of fungal infections, their rate, associated risk factors, and complications could contribute to reducing both financial and life costs, choosing targeted antifungal treatment, and avoiding unnecessary toxic treatments in individuals who are not suffering from mycoses.

 This prospective cross-sectional study was conducted in the first semester of 2019. All patients with hematologic malignancies (HM) admitted to Dr. Shariati Hospital were studied. Only those with probable/proven IFIs defined according to the last update of EORTC/MSG criteria were included in the study. The demographic and clinical data were recorded from the hospital information registration system using a questionnaire. Statistical analysis was performed using SPSS software version 24.

Out of 1109 HM patients hospitalized during the study period, 67 (6.04%) IFIs were diagnosed. Of these, 57 (85.04%) were aspergillosis, 7 (10.4%) were mucormycosis, and 3 patients developed other fungal infections. Males constituted 67.2% of the entire IFI population. The mean±SD age of the samples was 43.16 ± 13.8 years. The most common type of malignancy was AML. Lung imaging showed lesions associated with fungal infections in 52 cases (77.6%), with multiple nodules as the most prevalent pattern being observed in 64.2% of cases. Sinus involvement was evidenced in the PNS CT scan of 46 (68.6%) patients. The attributable mortality rate for IFIs was 62.7%. Both the types of IFI and malignancies had no significant relationship with the outcome of patients. Central venous catheter, mucositis, and antibiotic use were the most frequent risk factors.

  IFI represents a frequent complication for HM patients with high mortality. Aspergillus species are the predominant etiology in these settings. Considering our results, in high-risk patients, manifestations of warning signs in the sinus and lungs, which would not be cleared despite receiving antibiotics, should raise the possibility of IFIs.

Cerebral mucormycosis (CM) is a life-threatening manifestation of mucormycosis, an angioinvasive fungal infection caused by Mucorales. We sought to systematically review all available case reports to describe epidemiologic features, clinical manifestations, predisposing factors, and diagnostic and treatment strategies of CM. A systematic search was conducted using a combination of the following keywords: "Mucor", "Zygomycetes", "mucormycosis", "cereb*", "brain", "central nervous system", and "intracranial", separately and in combination until  December 31st 2018. Data sources included  PubMed, Scopus, EMBASE, Web of Science, Science Direct, and Proquest without limiting the time of publication. We included 287 articles corresponding to 345 cases of CM. Out of the 345 cases, 206 (60%) were male with a median age of 44 years; 130 (38%) were reported from North America; 87 (25%) from Asia; and 84 (24%) from Europe. The median time from onset of symptoms to presentation was 3-7 days (65/345, 65%). The highest mortality was observed among patients with diabetes mellitus (P=0.003). Debridement of infected brain tissue was associated with improved survival in CM cases (OR 1.5; 95% CI 01.3-1.8; P<0.0001). The use of liposomal amphotericin B (L-AMB) was significantly associated with patients' recovery (OR 2.09; 95% CI 1.2-3.4; P=0.003). The combination of L-AMB and posaconazole (12.5%) was more effective than the monotherapy treatment of CM cases (P=0.009). Clinicians should consider DM as an important risk factor for CM. Moreover, surgical debridement and antifungal combination therapy could be an effective approach in the management of CM patients.

Chronic renal failure and its end-stage disease are one of the most important causes of death and disability, and its prevalence is increasing in the world. This disease can cause many complications in the patients with end- stage renal disease.

The present study aimed at comparing cognitive impairment in patients with end- stage renal disease (ESRD) and chronic renal failure (CRF) with a control group.

In this cross-sectional study, 85 ESRD, dialysis dependent patients, 200 CRF patients, non-dialysis dependent, as well as 180 patients with high blood pressure or diabetes as control group who referred to Kowsar hospital during 2015 and 2016 were studied. The Persian version of the mini mental status examination (MMSE) questionnaire was used to collect data. It was completed by one of the skilled and trained nurses.

The results revealed that 28.2% of ESRD, 1% of CRF patients, and 0.6% of control group patients had severe cognitive impairment. Cognitive health score in ESRD group was lower than that in CRF (P < 0.001) and control group (P < 0.001). In addition, cognitive health score of CRF patients was lower than that in the control group (P = 0.005). ESRD patients had significantly higher impairment in time and place orientation, calculation, recall, language, and repetition compared to control and CRF groups (P < 0.001), but there were no significant differences between control and CRF groups. With respect to complex commands, the control group had a significantly lower impairment, but the other 2 groups were not significantly different in this regard. The three experimental groups were not significantly different in per-test stage.

ESRD patients have severe cognitive impairment compared to CRF patients. Therefore, it is recommended that these patients be examined cognitively and proper rehabilitation programs be considered for them