fariba keramat

The outbreak of the COVID-19 pandemic started in Wuhan, China, in December 2019 and spread rapidly around the world. Effective indicators to evaluate the severity and clinical progress of the disease need to be further investigated so that they can be used to reduce mortality. We sought to analyze the laboratory findings of some cases of coronavirus pneumonia in Iran.
This was a retrospective study of patients hospitalized with confirmed COVID-19 at Sina Hospital, affiliated with Hamadan University of Medical Sciences, between March 20, 2020, and June 21, 2021.
The mean age of the 1400 patients was 57.2±16.18 years, of which 64.2% (896 patients) were over 50, 52.6% were men, and 85.95% were in the critical group. A total of 508 patients (78.0%) had hypoalbuminemia. Creatinine and blood urea nitrogen (BUN) levels increased in 16.2% and 12.5% of patients, respectively. Regarding liver enzymes, 27.7% of patients had an increase in the alanine aminotransferase (ALT) enzyme, and 46.3% also showed an increase in the aspartate aminotransferase (AST) enzyme.
A decrease in serum albumin, increased liver enzymes, and changes in kidney function tests were observed in patients with coronavirus. Moreover, it was found that these changes were associated with inflammatory markers. Screening and daily monitoring of patients lead to early identification of risk factors in patients.

 Different vaccines have so far been developed and approved to cope with COVID-19 in the world. The aim of this updated network meta-analysis (NMA) was to compare and rank all available vaccines in terms of efficacy and complications simultaneously.

Study Design: 

A systematic review.

 Three major international databases, including Web of Science, Medline via PubMed, and Scopus, were searched through September 2023. The transitivity assumption was evaluated qualitatively in terms of epidemiologic effect modifiers. The exposure of interest in this study was receiving any available COVID-19 vaccine, and the primary outcome of interest was the incidence of symptomatic COVID-19. In this NMA, the relative risk of symptomatic COVID-19 was used to summarize the efficacy of vaccines in preventing COVID-19. The data were analyzed using the frequentist-based approach, and the results were reported using a random-effects model. Finally, the vaccines were ranked using a P-score.

 In total, 34 randomized controlled trials (RCTs) met the eligibility criteria for this systematic review and NMA out of 3682 retrieved references. Based on the results of the NMA, mRNA-1273 was the most effective vaccine in preventing COVID-19 and demonstrated the highest P-score (0.93). The relative risk (RR) for mRNA-1273 versus placebo was 0.07 (95% confidence interval [CI]: 0.03, 0.17). The second and third-ranked vaccines were BNT-162b2 (RR=0.08; 95% CI: 0.04, 0.15; P-score=0.93) and Gam-COVID-Vac (0.09; 95% CI: 0.03, 0.25; 0.88).

 Based on the results of this NMA, it seems that all available vaccines were effective in COVID-19 prevention. However, the top three ranked vaccines were mRNA-1273, BNT-162b2, and Gam-COVID-Vac, respectively.

All age groups are at risk of contracting and dying of Coronavirus disease (COVID-19). However, older people and those with underlying conditions, comorbidities and disability levels are at higher risk of developing a serious illness, especially those living in enclosed spaces such as nursing homes and care centers, are more vulnerable to getting this disease, which can become fatal during this pandemic. Other reasons that make them more susceptible include population density, sharing equipment, poor public health measurements and infection controlling and close contact with roommates, which may all these factors increase the transmission rate and risk of infection. Therefore, we aimed to investigate the outbreak of COVID-19 in a chronic psychiatric rehabilitation center called Behboud center in Hamadan, west of Iran. It is a rehabilitation center with 85 women clients and 16 staff.

Brucellosis is recognized as one of the most prevalent diseases among humans and animals. This study investigated and followed up brucellosis in seropositive participants in the Famenin (Hamadan province, Iran) cohort of brucellosis and their families by culture and serology methods.

Blood samples were taken from 66 subjects, including 18 subjects in the Famenin brucellosis cohort study with antibody titers≥1:180 and 36 subjects from their families and 12 subjects in the Famenin brucellosis cohort study with antibody titers<1:80. In the serological method, standard tube agglutination test (STAT positive with≥1:80) and 2-mercaptoethanol (2-ME) test (positive with≥1:40) were performed using the patient serum. Finally, 8 cc of the blood of all subjects was used for culture in the BACTEC culture medium.

Of the 66 serum samples, 20 (30.3%) samples, including 5, 4, and 10 samples at 1:20, 1:40, and 1:80 dilution, respectively, and 1 sample at 1:160 dilution were positive by the STAT, of which 13 (65%) samples belonged to patients’ family members. Using the 2-ME test, 10 (15.2%) serum samples were positive, of which 5 (50%) cases were related to patients’ family members. Eventually, no growth of Brucella was observed in 66 flasks of the BACTEC culture medium.

Considering that a definite diagnostic method is not yet accessible, a combination of methods must be applied to diagnose the disease.

The COVID-19 crisis poses a heightened risk to vulnerable populations. Considering factors influencing deterioration, complications, and mortality, it is especially important to pay attention to these groups, including persons with hypertension (HTN) and diabetes. This study aimed to investigate the correlation between the angiotensin II (ANG II) level and the disease severity and clinical course in COVID-19 patients.

A cross-sectional study was conducted on 50 COVID-19 patients (mean age 59.1 ± 20) admitted to Sinai hospital in Hamedan. The blood samples of the patients were taken during hospitalization and discharge, and the plasma ANG II level was measured using an enzymelinked immunosorbent assay kit. The quantitative comparison was analyzed with paired t test and qualitative comparison with the chi-square test. The correlation of variables was checked with the Pearson test, and P < 0.05 was considered statistically significant.

Overall, 44%, 16%, and 10% of COVID-19 patients had HTN, cardiovascular disease (CVD), and 10% diabetes, respectively. The oxygen level of 82% of the patients was below 90, of which 68% were intubated, and the lowest oxygen levels were observed in patients with HTN and CVD with 2 deaths. The primary and secondary examination of the ANG II level demonstrated that its level was significantly higher during illness compared to full recovery and decreased during recovery.

The ANG II level is related to the severity of the disease in the early stages of 2019- nCoV infection. Therefore, HTN or other diseases that affect the level of ANG II in the blood can increase the severity of the disease.

 Uropathogenic Escherichia coli (UPEC) is the most prevalent causative agent of urinary tract infections (UTIs) in both community and hospital settings. Annually about 150 million people globally develop UTIs, resulting in increased healthcare costs. The current study examined the identification and the frequency distribution of virulence factors among fluoroquinolones-resistant (FQs-R) and fluoroquinolones-susceptible (FQs-S) UPEC strains in Hamadan hospitals, west of Iran.

 One hundred-seventy urine samples were collected consecutively from inpatients at three hospitals in Hamadan from March to September 2018. The UPEC isolates were identified using biochemical tests and polymerase chain reaction (PCR). The disk diffusion and the broth microdilution methods determined the antimicrobial susceptibility and the minimum inhibitory concentration (MIC) of Ciprofloxacin. The multiplex-PCR method investigated the prevalence of pap, aer, and hly genes.

Among 170 urine samples collected from inpatients, E. coli was the most common isolate, with a frequency of 125 (73.5%). Resistance to Nalidixic acid and fluoroquinolones, including Ciprofloxacin, Norfloxacin, and Ofloxacin, was detected in 88.8%, 71.2%, 70.4%, and 68.8% of UPEC isolates, respectively. The prevalence of hly and pap genes in FQs-R strains was significantly lower than in FQs-S strains.

 The high-level antibiotic resistance to quinolones & fluoroquinolones and heterogeneity of virulence genes among clinical UPEC isolates need strong attention.

Due to the critical condition of COVID-19, it is necessary to evaluate the efficacy of administrating convalescent plasma to COVID-19 patients. Therefore, we decided to design a clinical trial to investigate the effect of convalescent plasma of patients recovered from COVID-19 on the treatment outcome of COVID-19-infected patients.
In this parallel randomized controlled clinical trial, patients in the intervention group received standard treatment plus convalescent plasma of patients recovered from COVID-19. We allocated 60 patients to each treatment group through balanced block randomization. Then, COVID-19 outcomes, vital signs, and biochemical parameters were compared between the two treatment groups by the independent t test and ANCOVA.
The mean age (SD) of the patients in the intervention and standard treatment groups was 52.84 (15.77) and 55.15 (14.34) years, respectively. Although patients in the intervention group reported more hospitalization days (11.45±5.86 vs. 10.42±6.79), death rates (26.67% vs. 18.13%), ICU admission (45 vs. 41.67%), and ARDS (11.67% vs. 3.33%), these differences were not statistically significant (P>0.05). Moreover, the two groups were homogenous in vital signs and biochemical parameters before and after treatment (P>0.05).
The present study indicated that convalescent plasma therapy has no significant effect on the survival, hospitalization, and ICU admission of COVID-19 patients.

Unknown cases of pneumonia appeared in late 2019 in Wuhan, China. Following the worldwide spread of the disease, the World Health Organization declared it a pandemic on March 11, 2020. The total number of infected people worldwide as of December 16, 2020, was more than 74 million, more than one million and six hundred thousand of whom died from Coronavirus Disease 2019 (COVID-19). This study aimed to identify the risk factors for the mortality of COVID-19 in Hamadan, west of Iran.
This cross-sectional study used the information of all patients with COVID-19 admitted to Shahid Beheshti and Sina hospitals in Hamadan during January 2020-November 2020. Logistic regression model, decision tree, and random forest were used to assess risk factors for death due to COVID-19.
This study was conducted on 1853 people with COVID-19. Blood urea nitrogen change, SPO2 at admission, the duration of hospitalization, age, neutrophil count, lymphocyte count, number of breaths, complete blood count, systolic blood pressure, hemoglobin, and sodium were effective predictors in both methods of decision tree and random forest.
The risk factors identified in the present study may serve as surrogate indicators to identify the risk of death due to COVID-19. The proper model to predict COVID-19-related mortality is random forest based on sensitivity.

Urinary tract infections are among the most common diseases in different communities and occur in all age groups. Failure to diagnose the disease correctly and promptly can cause complications such as damage to the urinary tract and kidney parenchyma, increased blood pressure, uremia. Also, in pregnant female patients It may lead to premature birth and even abortion. Therefore, correct and timely administration of antibiotics is very important in the treatment of patients. This study aimed to compare the results of antibiogram testing of patients with suspected urinary tract infections by both rapid and classical methods.

This cross-sectional study was performed from the beginning of March to the beginning of September 2019, on patients with urinary tract infection Who had been referred to Sina Hospital of Hamedan, Iran. Urine samples were collected 20 cc from patients. The test was performed directly at the same time with urine culture to determine antibiotic susceptibility. The agreement between the two methods was considered as a huge error, major error and minor error. Finally, the data were statistically analyzed with SPSS software version 16.

92 patients, 23 men (25%) and 69 women (75%) with a mean age of 53.18±18.49 years were included in the study. Direct testing had a significant agreement with the standard test in 90.8% of the results (P<0.001). 9.2% of the antibiogram tests did not match, of which 0.3% were huge errors, 4.7% were major errors and 4.2% were minor errors. The highest number of microorganisms found were Escherichia coli (n=66), Klebsiella pneumoniae (n=13), Pseudomonas aeruginosa (n=6), Acinetobacter (n=1), Enterococcus (n=2), Alcaligenes (n=1), Streptococcus (n=1), Staphylococcus haemolyticus (n=1) and Moraxella (n=1) respectively. The highest rates of urinary tract infections were with Escherichia coli, third-generation cephalosporin antibiotics, and broad-spectrum antibiotics.

The agreement between the direct and standard antibiogram method was acceptable, and the direct antibiogram method can be cited by doctors in many cases.

Identifying the potential risk factors of the length of stay in hospital (LOSH) in COVID-19 patients could help the health system meet future demand for hospital beds.

This study aimed to determine the factors affecting the length of stay in hospital in COVID-19 patients in Hamadan, the west of Iran.

This cross-sectional study recruited 512 hospitalized COVID-19 patients in Hamadan city. Demographic, clinical, and medical laboratory characteristics of the patients and their survival status were assessed by a checklist. Univariate and multiple negative binomial regressions were used by Stata 12.

The median hospitalization length for COVID-19 patients was five days (range: 0 to 47). In the discharged patients, the adjusted incidence rate ratios (95% CI) of LOSH for females, rural residents, patients with a history of diabetes and cardiovascular disease, SPO2 less than 88%, prothrombin time higher than 13 s, platelet count lower than 130 × 1000 µL, blood sugar higher than 105 mg/dL, and intensive care unit experience were 1.16 (1.03, 1.44), 1.22 (1.03, 1.44), 1.43 (1.07, 1.92), 1.41 (1.23, 1.61), 0.82 (0.71, 0.93), 1.32 (1.11, 1.56), 1.18 (1.03, 1.36), and 1.85 (1.59, 2.17) compared to their references, respectively.

Our study added new insight into LOSH determining factors that could be used for future planning in combating the need for hospital beds. The present study revealed that some demographic, social, and clinical variables could increase the IRR of a more extended hospital stay.

Neosporosis is a parasitic disease caused by Neospora caninum. This parasite is an obligate intracellular coccidia similar to Toxoplasma gondii with a global distribution. With regard to the experimental studies, vertical transmission of the parasite in the monkey (non-human primates) has increased the concern about the zoonotic potential of this disease. The principal aim of the current research was to perform a mini- review on investigations regarding the Neospora infection in humans on a global scale for the first time.

All peer-reviewed articles (published until April 2021) on the Neospora infection in humans were searched in English databases such as Google Scholar, ScienceDirect, Scopus, PubMed, and ProQuest.

Based on data in the available articles, the presence of antibodies against the Neospora infection was between 0 and 37.7% in people from different countries. The seroprevalence rate of this infection in HIV- positive individuals was higher (26.6% and 37.7%) compared to other cases. Finally, the genomic DNA of Neospora was detected up to 1% using molecular biology techniques.

Overall, the detection of anti-Neospora antibodies in humans indicated that people have been exposed to the parasite. Comprehensive research studies are essential for clarifying the risk factors associated with the Neospora infection in humans. This report provides the baseline information for future researchers. Molecular investigations and genotypic works on N. caninum isolates are highly recommended as well.

Pyoderma gangrenosum (PG) is a rare inflammatory skin disease. Due to the similarity of the disease with other skin lesions, it is difficult to diagnose it. Herein, we report an interesting case of PG on the right leg.

 A 43-year-old woman admitted to the infectious ward of Sina hospital (Hamadan, Iran) in March 2021with a painful ulcer on her right leg from 6 months before following trauma. The wound had a purulent discharge and bleeding spots. The patient also had a history of liver transplantation due to primary biliary cirrhosis ten years before, and was diagnosed with ulcerative colitis in August 2020. She had a blood transfusion every 6 months due to anemia. A skin biopsy was obtained from the patient's ulcer, and the specimen was sent for bacterial culture and histopathology. Enterococci were seen in culture, and the histopathology was in favor of PG. Treatment with parenteral vancomycin and oral prednisolone was started, and the lesion cleared almost completely after three weeks. Three months later, the patient was visited again and no recurrence was observed.

Clinicians should consider the diagnosis of PG in necrotic ulcers following local trauma, especially in patients with associated systemic diseases, </em>in order to start the appropriate treatment as soon as possible.

Brucellosis is a common zoonotic disease with protean clinical manifestations. Osteoarticular involvement is the most common complication of the disease. This study aimed to compare the clinical and para-clinical manifestations of brucellosis among the patients with and without spondylodiscitis.

In this comparative and cross-sectional study, 135 patients having brucellosis with and without spondylodiscitis and admitted to Sina hospital in Hamadan, Iran from March 2009 to March 2014 were included. Clinical and para-clinical data of the patients were obtained from their medical records in the hospital based on a designed checklist.

Thirty-five patients having brucellar spondylodiscitis (BS) with the mean age of 55.60 ± 14.31 years, and 100 patients having brucellosis without BS with the mean age of 43.27 ± 18.35 years were examined. A significant difference was found between the mean age of the patients with spondylodiscitis and that of those without spondylodiscitis (P < 0.001). All patients with spondylodiscitis complained of back pain and vertebral tenderness, while 60% of the patients without BS suffered from back pain but experienced no vertebral tenderness (P = 0.003). The most common vertebral involvement in spinal MRI of the patients with BS was L4-L5 (45.7%). Patients with spondylodiscitis had more increased ESR and CRP than those without spondylodiscitis (P < 0.001).

It is recommended that Brucellar spondylodiscitis be considered in the differential diagnosis of the patients with prolonged fever, back pain, and vertebrae tenderness in the endemic areas.

Coronavirus disease 2019 (COVID-19) has spread widely throughout the world and become a pandemic disease. In this study, we decided to investigate the chest computed tomography (CT) findings in COVID-19 patients in Hamadan, west of Iran. 

This cross-sectional study was conducted on 101 patients with confirmed COVID-19 infection from February to March 2020. Demographic, clinical, laboratory, and chest CT findings of identified COVID-19 patients were assessed. 

The mean age of the patients was 55.21 ± 14.08 years, and 54 (53.47%) of them were male. With regard to clinical manifestations, 82.18%, 72.28% and 54.46% of COVID-19 patients had dry cough, dyspnea, and fever, respectively. The right lower lobe was the most commonly and severely involved lope (69%), followed by left lower lobe, right middle lobe, and lingual segment; however, the anterior segment of upper lobes showed the least involvement with abnormality in the late course of the disease. The most common pattern was ground glass opacity (GGO), but atypical patterns such as round pneumonia, moderate to severe pleural effusion, and segmental lobar consolidation were seen without evidence of mediastinal adenopathy, cavitation, or nodular lesion. Chest X-ray (CXR) was not a sensitive method as the first-line imaging method because 34.65% of them were normal. 

CXR is not a sensitive method as the first-line imaging method (34.65% normal first CXR), but chest CT is a very sensitive and nonspecific modality for diagnosis of COVID-19. The lower lobe and posterior basal segments of the lungs are the most involved sites in most cases. About 12% showed atypical chest CT findings.

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a newly identified coronavirus. Our knowledge about the survival rate and prognostic factors of the disease is not established well. The purpose of this study was to evaluate the predictors of COVID-19 mortality in Hamadan province in western Iran.

In this study, we included all laboratory-confirmed COVID-19 cases with known treatment outcomes in Hamadan province, Iran, between 20, 2020, to May 10, 2020. Demographic, clinical, laboratory data, and treatment outcomes were obtained from computerized medical records and compared between survived cases and patients with death outcomes. Univariable and multivariable logistic regression models were used to determine the predictors of death.

From 749 investigated patients, 77 patients (10.28%) died during the treatment. The Mean age of patients was 53.97±19.04 years. Multivariable logistic regression showed that males had 2.07 (95% CI: 1.73, 2.54) fold higher odds of death. Those with 60 years old and more had 6.49 (95% CI: 4.53, 7.93) fold higher odds of death. Patients with an underlying disease had 7.14 (95% CI: 6.94, 7.38) fold higher odds of death, and patients who were hospitalized in the ICU ward had 2.24 (95% CI: 1.75, 2.90) times higher odds of COVID-19 related mortality.

The potential predictors of death in COVID-19 cases, including the male gender, older age, and having an underlying disease could help physicians to identify patients with poor prognoses at an early stage and better management of them.

This study aimed to determine the secondary attack rate (SAR) and its determinants to describe the clinical features and epidemiological aspects of patients and determine the risk factors of COVID-19 among household contacts in Hamadan Province, west of Iran. Study design: A cohort study.

In this cohort study, a total of 323 index cases and 989 related close contacts ages more than 15 years old (family members, relatives, and co-workers) were enrolled using a manual contact tracing approach, and all participants were tested by reverse transcription polymerase chain reaction test. In this research, the frequency of symptoms was assessed, the SAR among contacts of index cases was calculated, and the risk factors of COVID-19 were evaluated by the logistic regression model.

The secondary attack rate for total household members of index cases was estimated at 31.7% (95% CI: 28.8-34.7). It was found that among household contacts, the highest SARs were related to spouses 47.1% (95% CI: 38.7-55.7) and grandparents/parents 39.3% (95% CI: 29.4, 49.9) of index cases, who had also higher risks to become secondary cases (adjusted odds ratio [OR]=2.98, 95% CI: 1.31-6.75 and adjusted OR=2.76, 95% CI: 1.18-6.44, respectively). Considering the occupation of contacts, unemployed and retired people and housewives were most susceptible for transmission of COVID-19. It was revealed that cough was the most prevalent symptom among index and secondary cases.

Our findings indicated that spouses and grandparents/parents of index cases were the most susceptible individuals for COVID-19 transmission. Prolonged exposure with index case before COVID-19 diagnosis raised the chance of infection among secondary cases.

The increased resistance of microorganisms to common antibiotics is one of the major therapeutic challenges for patients. The present study aimed to compare the antibiogram results of two types of antibiotic discs and validate them by the Epsilometer test (E-test) method on bacteria with high antibiotic resistance patterns.

This descriptive-analytical study was performed by the census method on 176 patients admitted to different wards of Sina Hospital in Hamadan from March 2016 to March 2019. The patients entered the study with a positive culture result and underwent the antibiogram using two types of discs. Following that, validation was performed by the E-test method in cases with significant differences. Finally, the results were described and analyzed in SPSS software (version 16) at a 95% confidence interval.

Out of 176 patients, 80 (45.4%) and 96 (54.5%) cases were male and female, respectively. The mean age of patients was reported as 62.44.±20.47 years. The most common culture sites were trachea (45.5%) and urine (42.6%), and the most common cultured microorganisms were E.coli (33.5%), Klebsiella (29.5%), and Acinetobacter (18.8%). The highest correlation coefficients of the results by disk diffusion method were observed in levofloxacin (r=1.00), piperacillin (r=0.917), ciprofloxacin (r=0.907), cotrimoxazole (r=0.904). On the other hand, the lowest correlation coefficients were related to imipenem (r=0.634), cefoxitin (r=0.556), and ceftriaxone (r=0.552).

As evidenced by the obtained results, significant differences were detected between the results of antibiogram in Iranian and imported disks. After verification and validation using E.test, the percentage of agreement was in favor of imported disks.

Brucella is an intracellular pathogen that causes brucellosis in humans and animals. This study aimed to assess the results of brucellosis seroprevalence among participants of the Famenin brucellosis cohort with molecular investigation technique and determine Brucella-approved species.

Following the first phase of the Famenin brucellosis cohort in 2016 which investigated the seroprevalence of brucellosis among 2367 participants in Famenin city, a total of 575 people including all seropositive and some seronegative people were examined again by wright serological tests in 2019. The PCR assay was accomplished on all cases that have wright titers ≥ 1/20 for tracing Brucella DNA using BCSP31 target gene and IS711 locus.

Out of 575 studied cases, 145 people had wright titers ≥ 1/20. The PCR reactions of these 145 blood samples were positive in 63/145 (43.44%) tested samples using primers (B4/B5) for Brucella genus detection. In the second PCR assay using specific-primers for Brucella abortus and Brucella melitensis, 18/63 (28.57%) of the samples were diagnosed as B. abortus, and 18/63 (28.57%) were diagnosed as B. melitensis.

In this study, using the selected specific genes for the diagnosis of Brucella in the genus and species levels, the PCR technique was evaluated as a promising method for the rapid and safe detection of brucellosis besides the serological test for more accurate detection of brucellosis especially in cases that are not definitive.

Acinetobacter infection is one of the most common nosocomial infections that its antibiotic resistance has increased in recent years.This study aimed to evaluate drug resistance to colistin in nosocomial infections with multidrug-resistant (MDR) Acinetobacterbaumannii.

This cross-sectional study was performed on 45 blood or body fluid culture samples collected from hospitalized patients at Sina Hospital, Hamadan, Iran, within 2018-2019.The Minimum Inhibitory Concentration (MIC) was determined using E-test trips and disk diffusion method to evaluate the resistance of Acinetobacterbaumannii to the antibiotic colistin according to the guidelines of the Clinical and Laboratory Standards Institute.The collected data were analyzed in SPSS software (version 16).

In this study, out of 45 patients, 24 (53.3%) and 21 (46.7%) of the subjects were male and female, respectively.The mean age of patients was estimated at 68.0±15.9 years. The antibiotic-resistance of samples was determined using the disk diffusion method. Accordingly, all samples were 100% resistant to ceftriaxone, ceftazidime, ciprofloxacin, cefepime, imipenem, meropenem, ampicillin sulbactam.Out of 45 culture samples examined with MIC, 39 (86.7%) and 6 (13.3%) of samples were sensitive and resistant to colistin, respectively.Based on the results of the disk diffusion method, 21 (46.7%), 19 (42.2%), and 5 (11.1%) of samples were sensitive, intermediate, and resistant to colistin

Based on the findings, colistin was effective against multidrug-resistant Acinetobacterbaumannii and is suggested to be used in cases of Acinetobacter MDR as an effective treatment in combination with other antibiotics.

Brucellosis is endemic in Iran with a higher level of endemicity in western areas, including the Hamadan province. This study aims to define the seroprevalence of brucellosis and it,s risk factors in general the population of Famenin, Hamadan province, in western Iran.

This survey was conducted on 2367 participants in Famenin and its villages from September to November 2016. After receiving written consent from subjects, demographic information was obtained through questionnaires and 10cc blood samples were taken from the participants. Blood samples were sent to the Core facility of Hamadan University of Medical Sciences and were tested using Wright and 2ME kits (Pasteur Institute, Iran) for serological detection of brucellosis. The seroprevalence of brucellosis was reported as percentage with 95% confidence interval (CI).

Totally, 2367 individuals with the mean age (SD) of 34.6 (20.9) (range: 2 to 95) years were enrolled. Of these, 1060 (44.8%) were men and 1610 (68.0%) lived in rural areas. The seroprevalence of brucellosis according to the Wright titer (equal to or greater than 1:80) was 6.6% (95% CI: 5.62%, 7.66%). The corresponding prevalence based on 2ME titers (equal to or greater than 1:40) in subjects with positive Wright test was 37.2% (95% CI: 29.5%, 44.84%). We saw a significant association between the incidence of brucellosis and occupation (P < 0.001) and type of contact with livestock (P = 0.009) as two important risk factors.

The seroprevalence of brucellosis in Famenin population was considerable. Contact with livestock, animal husbandry, farming and history of brucellosis were risk factors for brucellosis infection.

Infectious diseases are among the most serious diseases that may lead to death in many parts of the world. This study was conducted to investigate the main causes of mortality among patients hospitalized in the infectious ward and respiratory ICU of Sina hospital in Hamadan.

The medical records of patients hospitalized from March 2012 to March 2017 in the infectious ward and respiratory ICU were investigated, those not surviving during the hospitalization.

A total of 593 medical records of patients were reviewed, of which 534 cases were enrolled in this study. Among which, 426 (79.8 %) and 108 (20.2%)cases were related to patients hospitalized in the respiratory ICU and infectious ward, respectively The mortality rate during 2012 to 2016 was calculated as follows: 4.69% in 2012, 6.31% in 2013, 4.68% in 2014, 5.2% in 2015, and 5.8% in 2016. This study results showed that the most common causes of mortality were sepsis (44.4%) in the respiratory ICU and pneumonia (25.3%) in the infectious ward. The highest rates of case fatality were related to sepsis (237cases, 48.2%) and pulmonary embolism (15 cases, 44.1%).

The present study findings showed that sepsis and pneumonia were the most common causes of death among patients hospitalized in the infectious diseases ward and respiratory ICU; also, sepsis and pulmonary embolism accounted for the highest case fatality rates.

Human immunodeficiency virus (HIV)-infected people are at higher risk of opportunistic infections due to immunodeficiency. The current study aimed to evaluate the different levels of CD4 in HIV-infected patients and its relationship with clinical and paraclinical manifestations of the patients.

This cross-sectional study was conducted on 94 HIV-infected patients referred to the Counseling Centers for Behavioral Diseases and Sina Hospital in Hamadan, from 2014 to 2015. At the commencement of the study, written consent was obtained from the participants. Thereafter, demographic data, history of underlying diseases, symptoms and clinical syndromes, medical history, and serum CD4 levels were evaluated by flow cytometric recorded in the questionnaire and data were analyzed in SPSS software(version 16).

Out of 66 HIV-positive patients, 70.2% (n=38) were male and the mean age of the patients was 40.06±10. 04 years. In terms of classification of the clinical stage of the disease, the patinets in the first, second, and third stages were reported as 11 (11.7%), 36 (38.3%) and 34 (36.2%), respectively. The mean serum CD4 count of the patients at the beginning of antiretroviral therapy was measured at 284.241±284 and 377.19±271.41 cells /μl, respectively. The difference in the mean of serum CD4 count before and after antiretroviral therapy was revealed to be statistically significant (P=0.001). The most common clinical symptoms observed included cough and sputum (29.9%), oral aphthous ulcer (12.7%), weight loss (11.7%), and fever (7.4%). Based on the results of the study, there was a significant difference between the mean of platelet count, hemoglobin and alkaline phosphatase at different levels of CD4 (P<0.05).

According to the results of the present study, serum CD4 levels rise with the initiation of antiretroviral therapy in HIV infected patients; therefore, early antiretroviral therapy in HIV-infected patients with any serum CD4 level is of paramount importance.

To achieve preventive and controlling activities of Brucellosis, we aimed this study as the first prospective cohort survey on brucellosis in Iran. This cohort in different phases from 2016 until 2020 going to investigate about brucella infection in selected population of Famenin, a city located in Hamadan province, west of Iran. Study design: A prospective cohort study.

At the first phase of study, Famenin inhabitants including urban and rural people were studied during September to December in 2016. All identified household’s people referred to specified health centers and clinically visited. Blood sampling was done, then these subjects were joined and the follow-up was initiated. At the next step, taken blood samples were examined using Wright kits and 2ME test for diagnosis the seroprevalence of brucellosis. Participants will be followed up for next years to examine clinical profiles of brucellosis and complete investigation about the main risk factors to reach strategies to control and reduce human and animal brucellosis.

In the first phase, according to statistical analysis, 3363 persons including 47clusters were enrolled and considered for future studies. All participants were interviewed and demographic questioners were successfully completed.  Finally, 2367 blood samples were entered in serology analysis.  The seroprevalence of brucellosis based on serologic titers of Wright and 2ME test was 6.59% (95% CI: 5.62%: 7.66%) and 3.46 %( 95% CI: 2.72%: 4.20%) respectively.

In the first phase, an extensive range of data and information were collected as the basic data for following phases of the cohort.

Infective endocarditis occurs due to the presence of microorganisms in the endocardium or the heart valves. Nowadays, infective endocarditis is still a major cause of death with an incidence rate of 5 to 7.9 per 100,000 populations. The aim of the study was to determine antibiotic resistance pattern of bacterial agents isolated from blood culture of patients with infective endocarditis. In this retrospective study, infective endocarditis patients who were admitted to Sina and Ekbatan hospitals in Hamadan City, Iran, from March 2005 to February 2014, were enrolled. All demographic data, clinical manifestations, physical examinations and echocardiography reports of the patients were recorded in a check list. For all patients, blood cultures in Mueller Hinton agar and antimicrobial susceptibility testing for ceftriaxone, ceftazidime, oxacillin, cefazolin, vancomycin, imipenem, clindamycin, etc. were done by disk diffusion method. All data analyzed by SPSS statistical software, version 16 (IBM, Armonk, NY, USA). A total of 61 patients with definitive infective endocarditis were included in the study, 50 of them (82%) were males and 11 patients (18%) were females. The mean age of the patients was 37.45±14.79 (range 17-74) years and 37 (60.7%) of the patients lived in urban areas. The mean duration of admission was 20±13.59 days. In addition, 38 patients (62.3%) were injection drug users (IDUs) and 23 (37.7%) non-IDU. Meanwhile, 54 (88.5%) of them had normal valve endocarditis and 7 cases (11.5%) had a prosthetic valve endocarditis. Moreover, the most common underlying disease in the natural valve endocarditis was rheumatoid fever (6.6%). Blood cultures were positive in 44.3% of the patients. The most common isolated organism was staphylococcus aureus in 15 cases (55.55%), which had the highest resistance to oxacillin. Most patients were managed by antibiotic therapy, but 15 cases (24.6%) underwent cardiac surgery. In follow up patients between 3 months to 9 years, 19.7% of the patients had complete recovery and 8.2% of them died. According to the findings, antibiotic resistance pattern of bacterial agents isolated from blood culture of patients with infective endocarditis was changed.

Patients with AIDS are at risk for contagious infections such as Epstein-Barr virus (EBV) infection. The aim of this study was to determine the prevalence of EBV infection in HIV-infected patients and compare it with healthy individuals in Hamadan province in the west of Iran. In a case-control study, 61 HIV-infected patients and 62 healthy individuals were enrolled. EBV viral capsid antigens (VCA) IgM and IgG antibodies were measured by chemiluminescent immunoassay system and CD4 cell count was measured by flow cytometry. Data were analyzed using SPSS (version 16). All HIV-infected patients (100%) had positive EBV VCA-IgG antibody while 57(91.9%) in the controls were positive (P = 0.02). There was no statistically significant relationship between CD4 cell count and the prevalence of EBV infection in HIV-infected patients (P = 0.4). However, there was a statistically significant relationship between the reduced CD4 cell count and rising EBV VCA-IgG antibody titer (P = 0.001). Moreover, there was no significant association between the prevalence of EBV infection and variables of age, sex and anti-retrovirus therapy in HIV-infected patients (P > 0.05). There was also a significant association between the antibody titer and antiretroviral therapy (P = 0.004). The high prevalence of EBV infection in HIV-infected patients, especially in the patients with a low CD4 count, could lead to high risk of EBV complications.