mahshid talebi taher

 This study aimed to investigate persistent symptoms of coronavirus disease 2019 (COVID-19) patients admitted to a general tertiary teaching hospital during a 9-month follow-up period.

In this study, 400 hospitalized COVID-19 patients in Iran were studied, among them 78 RT-qPCR positive cases were identified from February 19 to March 18, 2020. After excluding readmitted and deceased patients, 75 cases underwent in-hospital follow-up. Out-of-hospital follow-up was done for 57 living patients, of whom four cases were unreachable, and five cases died after discharge. The remaining 48 participants were followed up for nine months, and their symptoms and complaints were checked by regular visits to the infectious disease clinic and telephone calls via a checklist designed by the authors.

The mean age of RT-qPCR positive hospitalized patients was 54.64 ± 17.42 years, and 38.7% of them were female. Overall, five (10.4%) patients complained of dyspnea, three (6.2%) patients of olfactory nerve complications, three (6.2%) patients of persistent fatigue, and two (4.2%) patients of prolonged cough up to the end of the follow-up period. New-onset symptoms were reported in five (10.4%) patients; in most of them (4 out of 5), these symptoms were neurological (urinary retention, tremor with ataxia, distraction, and insomnia).

A large proportion of patients who recover from COVID-19 infection experience prolonged symptoms. Further investigations should be done to provid more data on the underlying causes and risk factors of developing these post-COVID conditions.

Microbial infections are one of the main causes of death in the intensive care unit (ICU) of hospitals. The aim of this study was to investigate the epidemiology of microbial infections in the ICU of Rasoul Akram Hospital in Tehran during the years 2016 -2018.

A retrospective study was conducted on 1150 patients in the ICU of Rasoul Akram Hospital in Tehran between 2016 and 2018. The required information was extracted from the medical records of hospitalized patients and then the data were analyzed.

Out of 1150 patients, 641 (55.7%) were men. The average length of hospitalization of patients with nosocomial infections in the ICU was 18±7.6 days. The most common cause of nosocomia infection was Klebsiella pneumonia. The highest frequency of death of patients was related to Ascentobacter. Also, other findings of the study showed that there was a significant direct relationship between the death and discharge of patients with nosocomial infections with the gender, type of organism, age, and length of hospitalization (p<0.05). The findings of the study also showed that infection was significantly associated with death (39.7%).

The findings of this study showed that the variables of gender, age, type of organism, and duration of hospitalization can be risk factors for the death of patients hospitalized in ICU. Therefore, preventive policies and control of nosocomia infections should be focused on these variables.

Hydatid cyst mainly involves the liver and lung; however, it can rarely involve cardiac tissue. This study describes the presence of hydatid cysts in the heart with considerable disease points in Tehran, Iran. Two cases aged between 25 to 50 years with cardiac hydatid cyst involvement were identified in 2021 in Tehran, Iran. Epicardial hydatid cyst between a left anterior descending coronary artery (LAD) and left obtuse marginal artery (OM) on the left ventricle, and in the second case, intrapericardial cyst attached to the pulmonary trunk with a thin base were identified. The cardial cysts were resected, and the patients recovered without any complications. Cardiac hydatid cyst is a very rare disease. Rapid diagnosis and surgical and medical care are necessary for treatment.

The recent rise of Invasive Fungal Infections (IFI), especially mucormycosis in COVID-19 patients, is further complicating the outcomes. Here, we present a case of concomitant rhino-orbital and breast mucormycosis after COVID-19. To the best of our knowledge, this is the first case of breast mucormycosis after COVID-19.

According to the World Health Organization, COVID-19 management focuses primarily on infection prevention, case management, case monitoring, and supportive care. However, due to the lack of evidence, no specific anti-SARS-CoV-2 treatment is recommended. This study aimed to evaluate the effectiveness of plasmapheresis treatment in COVID-19 patients with symptoms of pulmonary involvement on the computed tomography (CT) of the lung.  

In 2021, an experimental study in critically ill patients admitted to the COVID-19 ward in the Hazrat-e Rasool hospital diagnosed with COVID-19 was conducted in the second phase (pilot study). The diagnosis was confirmed according to clinical signs, CT scan of the lung, and the Polymerase chain reaction (PCR) test. All patients received the usual treatments for COVID-19 disease and underwent plasmapheresis at a dose of 40 cc/kg daily up to 4 doses. All patients were observed for 24 hours for complications of plasmapheresis treatment and simultaneously for symptoms of COVID-19, after which only routine care measures were performed. The next day and 2 weeks after resumption of the treatment, patients experienced COVID-19 symptoms, including shortness of breath, cough, and fever. Blood oxygen saturation, and treatment results were evaluated. Qualitative and rank variables were described using absolute and relative frequencies and quantitative parametric variables were used using mean and confidence interval. Frequencies were compared in groups using the chi-square test. All tests were performed in 2 directions and P ˃ 0.05 was considered statistically significant.   

Of the 120 patients studied, 79 (65.8%) were men and 41 (34.2%) were women. The mean age was 60.30 ± 15.61 years (22-95 years). The mean hospital stay was 12.89 days ± 7.25 days (2-38 days). Increased blood oxygen saturation levels in patients had an increasing trend. Inflammatory indices had a downward trend in patients. The frequency of plasmapheresis had no significant effect on reducing the downward trend of inflammatory markers. The greatest reduction occurred in the first plasmapheresis.  

Finally, according to the findings, plasmapheresis is one of the appropriate treatments to improve patients' symptoms and reduce cytokine storm. Recovered patients had lower levels of inflammatory markers than those who died.

Nutrition and infectious diseases are 2 influential factors. Mini nutritional assessment (MNA) score is one of the indicators for assessing the nutritional status of the patients. The present study aimed to evaluate the relationship between MNA– short form (SF) and the infectious status of patients admitted to the intensive care unit (ICU) of Hazrat-e-Rasoul hospital in Tehran.  

This was a cross-sectional study performed at Hazrat-e-Rasoul hospital in Tehran from 2019 to 2020. Each patient completed the MNA–SF questionnaire. The questionnaire has 6 factors with a score range of 0 to 14, with 12 to 14 indicating "normal nutrition," 8 to 11 indicating "at risk of malnutrition," and 0 to 7 indicating "malnutrition." The patients were monitored for clinical and paraclinical signs and symptoms of infectious disease for the first 14 days after being admitted to the ICU. Then, the relationship between infection level and MNA–SF scores were recorded and the chi-square, independent samples t test, and Pearson correlation test were used.  

In this study, 119 patients (60 men and 59 women), with a mean age of 53.82 ± 19.76 years were selected, and 71 (59.67%) of the patients had an infection. Women without infection were significantly more than men (p=0.021). In the assessment of the MNA–SF questionnaire, we found that 62 (52.1%) patients had "normal nutrition" status, 30 (25.2%), and 27 (22.7%) had "at risk for malnutrition" and "malnutrition" status, respectively. MNA–SF scores were significantly different in different age groups (p=0.040). There was a significant relationship between weight loss, mobility, and neuropsychological problems with age (p<0.001). Also, there was a meaningful relationship between nutritional status and infection (p=0.032). The results determined that noninfected cases among the patients with "normal nutrition" status were more than those "at risk for malnutrition" (p=0.007). The results of this study showed that clinical outcomes had a significant relationship with nutritional status (p=0.043).  

Based on the present study, good nutritional status can reduce infection and mortality in patients who are admitted to ICU, and the nutritional status assessed with MNA-SF can play an essential role in patients' susceptibility to infection.

Coronavirus disease 2019 (COVID-19), the first pandemic caused by a human infecting coronavirus, has drawn global attention from the first time it appeared in Wuhan city of China in late December 2019. Detection of the responsible viral pathogen, named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by WHO, and its possible pathogenesis lead to the forming of many hypotheses about the factors that may affect the patients’ outcome. One of the SARS-CoV-2 infection concerns was the potential role of angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) in COVID-19 patients’ morbidity and mortality. Studies demonstrated that because SARS-CoV-2 uses human ACE2 cell receptors as an entry receptor to invade the cells, there might be an association between antihypertensive drugs such as RAAS inhibitors (specifically ACEIs and ARBs) and the COVID-19 disease. Data are scarce and conflicting regarding ACEI or ARB consumption and how it influences disease outcomes, and a single conclusion has not been reached yet. According to the literature review in our article, the most evidentially supported theory about the use of RAAS inhibitors in COVID-19 is that these medications, including ACEI/ARB, are not associated with the increased risk of infection, disease severity, and patient prognosis. However, further studies are needed to support the hypothesis.

Nosocomial infections can be a major challenge for medical staff and health care providers when it comes to antibiotic-resistant bacteria. Enterococcus faecalis is one of the bacteria that play an important role in nosocomial infection. Therefore, it is important to study the prevalence and pattern of resistance of this bacterium in medical centers, especially in hospitals. Inappropriate use of antibiotics has led to the increasing spread of resistant bacteria. Enterococci are now considered not only for their role in nosocomial infections but also for their increasing reistance. The parts of the body that are most infected with this bacterium are the urinary tract and blood. Enterococcal infections are very common in patients with vascular and urinary catheters, and in patients who have been hospitalized for a long time and have taken broad-spectrum antibiotics.  The aim of this research was study of phenotypic resistance pattern of E. faecalis isolated from blood and urine samples of patients admitted to Rasoul Akram General Teaching Hospital.

This case series study was performed from February 2019 to January 2020 at Rasoul Akram Hospital in Tehran. The origin of the isolated E. faecalis was urine and blood which were isolated from patients with urinary tract infection and bloodstream infection from the hospital. The grown bacteria were evaluated by catalase test, then gram-positive catalase negative cocci were examined by L-pyrrolidonyl-beta-naphthylamide (PYR) hydrolysis (BY), bi-scolin, salt tolerance tests of 6.5%. Then biochemical tests were performed to detect E. faecalis, which included motion test, 0.04% tellurium reduction and pigment production test. E. faecalis isolates were isolated after biochemical tests. Antibiogram test was performed using disc diffusion method and E-test to measure the resistance of these isolates. Antibiogram test by disk diffusion method using discs (gentamicin 10 mg), (erythromycin 15 mg), (ampicillin sulbactam 10 + 10 mg), (ampicillin 10 mg), (penicillin 10 mg), (ticoplanin 30 mg), (Rifampin 50 mg), (30 mg linezolide) from HiMedia India. The bacterial suspension was prepared from fresh culture of E. faecalis with half McFarland turbidity and cultured on Müller-Hinton agar medium. Antibiotic discs were then placed on Müller-Hinton agar medium. Vancomycin E-Test: Some bacterial colonies were removed from fresh culture by ounce and dissolved in sterile physiological saline and concentrated to half McFarland concentration. After the bacterial suspension was completely absorbed into the medium, a strip containing the vancomycin concentration gradient was placed on Müllerhinton agar medium using a pair of sterile forceps and the culture medium was kept in a 37 ° C oven for 24 hours. By examining the plates, the number in front of the intersection of the non-growth halo with the E-Test strip was considered as a small amount of the minimum concentration of growth inhibitor.

From 53 isolated E. faecalis, 46 samples (86.8%) were isolated from the urine and 7 samples (13.2%) were isolated from the blood. The source of isolation of E. faecalis was blood and urine samples from nephrology, surgical ICU, neurosurgery, transplantation, inpatient emergency, MICU, general surgery, ICU, orthopedics, internal medicine and neurological ICU wards.  The most sensitive antibiotics for these isolates were Linezolid (52), 98.1%, Vancomycin (47), 88.7%, respectively and the most resistant antibiotics to these isolates were Gentamicin antibiotic (43), 81.1%, and rifampin (34), 64.2%.

Annual nosocomial infections kill many patients around the world. Excessive use of antibiotics in medicine and agriculture has led to the development of multidrug-resistant bacteria, which are now recognized as one of the leading causes of nosocomial infections. In addition to high patient mortality, imposing high economic costs on patients and hospitals and medical centers is another consequence of microbial resistance. Enterococci are one of the most important causes of nosocomial infections, especially in intensive care units. These bacteria can be easily transmitted from one patient to another in a hospital through medical staff. In patients, the most common sites of enterococcal infection are the urinary tract, blood, and ulcers.In a study conducted by Ghasemi et al., on multidrug resistance of E. faecalis in two hospitals of Kashan, no resistance to linezolid antibiotic was observed in these isolates. In another study conducted by Najafi et al., on enterococcal antibiotic resistance in Hamadan teaching hospitals, no resistance to linezolid antibiotics was observed. Loza et al., in Spain showed that 100% of isolated enterococcal isolates were sensitive to linezolid, vancomycin and ampicillin. In this study, the most sensitive antibiotic against E. faecalis isolates was Linezolid, which is consistent with the studies mentioned above. In a study by Al-Harthi et al., on the pattern of antibiotic resistance of E. faecalis from 2003 to 2006, resistance to gentamicin was 89.6%. In this study, E. faecalis isolates had the highest resistance (81.1%) to the antibiotic gentamicin, which could be a warning to the physicians in prescribing this drug. in a study by Ghasemi et al., in Kashsn resistance to penicillin antibiotic was29.2%.  In another study conducted by Yousefi et al., on antibiotic resistance of enterococci in Ghaem Hospital of Mashhad, resistance to penicillin antibiotic was 54.5% . In the present study, resistance to penicillin antibiotics in enterococci was 54.7%. In another study conducted by Hosseinizadeh et al,. on the pattern of enterococcal resistance in Arak teaching hospitals, resistance to vancomycin antibiotic by MIC method was 14.66% . In another study conducted in India in 2013 by Suddhanshu et al., out of a total of 150 samples collected from different wards of the hospital, only 5 isolates were E. faecalis resistant to vancomycin. A study conducted by Arbabi et al., in 2015 in Rasool Akram and Milad hospitals in Tehran, out of 149 isolated Enterococcus specimens, 60% of the specimens were E. faecalis isolates. The highest resistance (77.1%) based on disk diffusion test against gentamicin antibiotic and the lowest resistance (28%) based on MIC test against vancomycin antibiotic was observed. In this study, the resistance of E. faecalis to the antibiotic vancomycin, which was performed by Etest method, was reported to be 11.3%, which is less than the study of Nikoei et al., Hosseinizadeh et al., and Arbabi et al.

The resistance of E. faecalis to antibiotics is increasing. Therefore, periodic monitoring of the resistance pattern of this bacterium can help effectively treatment of patients and reduce treatment costs. E. faecalis and Enterococcus faecium are inherently resistant to certain antibiotics, including cephalosporins, aminoglycosides, clindamycin, and fusidic acid.

Treatment of multi-drug-resistant strains of pneumonia with common antibiotics in renal patients is ineffective and physicians are compelled to use Colistin for such cases.

This study was conducted to assess the mortality, length of stay, and renal damages in the treatment of multi-drugresistant pneumonia with Colistin among multiple trauma patients admitted to the emergency department and transferred to the ICU.

This retrospective cohort study was conducted between 2011 and 2016. 102 multiple trauma (MT) patients with multidrug-resistant strains of hospital-acquired pneumonia (HAP) admitted to the emergency department then transferred to the ICU were assessed. All patients received Colistin according to their weight. Renal damage was evaluated according to the RIFLE criteria. The mortality and the length of stay were assessed. In order to statistically analyze the data, SPSS version 23 software was used to conduct t-test and chi-square test.

Out of 102 patients, 55 (54%) died and 50 (49.1%) developed acute renal failure; 64 cases had no hypertension. Patients according to the RIFLE index were assessed: Risk (11.01%), Injury (14%), Failure (18%), Loss (6%), and End-stage renal disease. The prevalence and prognosis of acute kidney injury in multiple trauma patients treated with Colistin were significantly correlated with drug dosage, body mass index, and use of corticosteroids (when assessed using relevant scoring systems, P < 0.05).

The use of a scoring system in the intensive care unit, determining those patients requiring Colistin, and adjusting the dosage of this drug for treatment of MT patients with multi-drug resistant strains of HAP are vital. Creatinine levels must be carefully monitored.

The risk of tuberculosis (TB) is greater for individuals with human immunodeficiency virus (HIV) who are on combined antiretroviral therapy (c-ART) than for the normal population. Therefore, the detection and treatment of latent tuberculosis infections is recommended for all HIV-positive persons with positive tuberculin skin tests (TSTs).
This retrospective cohort study included all HIV-positive individuals with CD4 lymphocyte counts greater than 200 cells/µL and negative TST results, who were taking antiretroviral drugs and had been referred to Imam Khomeini Teaching Hospital Consultation Centre for Clients with Risky Behaviors in Tehran, Iran, from 2008 to 2013. TST conversion to positivity is defined as an induration increase of at least 5 mm compared with a previously negative TST result within a 1-year period. Conversion rates are expressed in person-years of observation.
A total of 113 patients were included in our study. At 1 year, 9 of the 113 TST-negative patients taking c-ART became TST-positive (8%; 8 males and 1 female). The TST conversion incidence rate was 10.09/100 person-years. TST conversion was only found to be associated with sex (odds ratio: 8.64; 95% confidence interval: 1.04–7.56, p = 0.032).
Our results suggest that TSTs should be administered to all HIV-positive patients before beginning isoniazid preventive therapy in Iran.

Health care workers (HCWs) are at the risk of the acquisition of occupational transmissible diseases. Controversial results have been reported about hepatitis C virus (HCV). The main objective of the recent study was to evaluate the seroprevalence of HCV and its relationship to the occupational history and exposure of HCWs in two teaching hospitals in Tehran-Iran.
A seroprevalence survey of HCV was conducted using serum samples obtained from 1400 HCWs in two teaching hospitals during 2012. The samples were screened by ELISA for the presence of anti-HCV antibodies.
In none of the participants the HCV antibody was detected. Needle stick injury was significantly higher among nurses. Younger HCWs with a shorter professional life had more frequent needle stick injury (p The seroprevalence of HCV in HCWs was considerably lower than that reported in the general population, and needs to be evaluated on a larger scale.

Wound infection is a predominant cause of death in burned patients who are clearly at increased risk of nosocomial infections. Pseudomonas aeruginosa is the most common cause of burn infections and is difficult to treat because of having high level of resistance to antibiotics. The aim of this study was to perform isolation, identification and determination of antibiotics resistance pattern of P. aeruginosa strains isolated from wounds of hospitalized burn patient. Biochemical and molecular tests were used for identification of the P. aeruginosa and antibacterial susceptibility test was performed using disk diffusion (Kirby- Bauer) methods. Then, the minimum inhibitory concentration (MIC) was performed for four representatives of different groups of antibiotics. Among 94 evaluated strains of P. aeruginosa, 83 isolates (88.3%) were multi drugs resistant. Based on Kirby-Bauer method, the most resistance was seen to cefepime (89.5 %) and among the antibiotics studied to determine the MIC, the most resistance was observed to ciprofloxacin (89 %). These results indicate high range of resistance to different antibiotics among strains of P. aeruginosa isolated from burn wounds of patients. So, the fast and accurate measurement and evaluation of antibiotic resistance for appropriate antibiotic therapy of burned patients is imperative.

One of the main components involving in the pathogenesis and prognosis of sepsis and septic shock is natriuretic peptide. Hemodynamic changes in sepsis or septic shock might explain increased plasma levels of these peptides circulations.. The present study aimed to assess the value of brain natriuretic peptide (BNP) in prediction of sepsis state and its related morbidity. We also attempted to determine the best cutoff point of BNP for diagnosis of sepsis state in those with critical illnesses, admitted to the hospital..Patients and In a cross-sectional study on critically ill patients referred to infections unit of Hazrat Rasoul Akram Hospital, the enrolled patients were assigned to one of the sepsis (n = 30) and nonsepsis (n = 30) groups, based on their results of blood culture and clinical manifestations. Plasma level of BNP was measured by immunoassay.. In-hospital mortality was only observed in one patient suffering from sepsis. Hospital length of stay (LOS) was significantly longer in the sepsis group compared with the nonsepsis one (17.47 ± 10.10 days versus 7.93 ± 2.92 days). The plasma BNP level, as a marker, was significantly higher in the sepsis group than the nonsepsis one (786.87 ± 164.11 ng/mL versus 154.57 ± 44.67 ng/mL, P = 0.039). The BNP level was significantly correlated with some baseline variables including respiratory rate (beta = 0.295, P = 0.022) and ESR measurement (beta = 0.296, P = 0.022), but not with other characteristics. Through multivariable linear regression analysis, having other patients’ variables information including demographics and hemodynamic parameters, the BNP level was significantly higher in the sepsis group compared with the nonsepsis one (odds ratio = 1.008, P = 0.046). According to the receiver operating characteristic (ROC) curve analysis, BNP measurement had an acceptable value for discriminating sepsis and nonsepsis states (c = 0.734, 95% CI: 0.605-0.864, P = 0.002). The optimal cutoff point of BNP for discriminating sepsis and nonsepsis states was 170 ng/mL, yielding a sensitivity of 66.7% and a specificity of 60.0%.. Elevated BNP level was associated with a significantly increased risk of sepsis state in critically ill patients..

Hospitals are hazardous environments for the emergence and transmission of tuberculosis. This study was carried out to evaluate the prevalence of latent tuberculosis infection (LTBI) and chest X-ray findings in health care workers (HCWs) with and without LTBI. A cross sectional survey was conducted in Rasool Akram hospital، Tehran، Iran. One hundred HCWs were tuberculin skin tested to measure LTBI and were asked for Chest X-ray to detect any lesions compatible with active or latent tuberculosis in two groups with and without LTBI. Chest x-ray findings were reported as: calcified nodule، fibrotic lesions، hilar adenopathy، tuberculoma، pleural effusion، and miliary. Statistical significances were analyzed by Chi-squared test. The obtained data were analyzed by SPSS version 16 software. A total of 100 HCWs were included in our study. Tuberculin skin test (TST) was positive in 49 (49%) cases. There was no significant difference between sex and positive tuberculin skin test. Abnormal findings in chest radiography were reported in 9 (9%) cases. There was no significant difference between LTBI and gender (P=0. 8). There was no significant difference between chest x-ray findings and LTBI (P=0. 5). Although nearly half of participants had positive tuberculin skin test، chest abnormality was reported only in nine percent. Specific tests and imaging such as QuantiFERON and chest CT scan seems to be more effective for latent tuberculosis diagnosis than TST among HCWs.

Varicella zoster virus (VZV) can cause life-threatening disease in pregnant women. The aim of this study was to identify the VZV immune status in pregnant women and also determine the validity of self-reported history for chickenpox. Serologic testing for VZV was performed for 400 pregnant women attending prenatal care at clinics located in two teaching and referral hospitals in Tehran, Iran. The Enzyme Immunoassay method was used to assess IgG antibodies against VZV. A total of 400 pregnant women, aged 16-43 years (median: 27 years, mean: 27.6 ± 5.9 years), were examined in which 361 (90.3%) were found to be seropositive. Sensitivity, specificity and positive and negative predictive values of patients’ self reported history were 51.8%, 71.7%, 94.4% and 13.8% respectively. Serologic screening for VZV in pregnant women seems crucial. We suggest considering the pregnant women as the target group for future immunization programs in Iran.

Determining the etiologic agents of septic arthritis is very important. The aim of the present study was to determine group A streptococcal polysaccharide antigens in synovial fluid of patients with arthritis. A cross sectional study was conducted upon 52 cases with acute mono arthritis in Hazrat-e-Rasool Akram hospital in Tehran، Iran (2010-2012). Gram staining، culture and rapid antigen tests were performed (LPA) for H. influenza، S. pneumonia، group B streptococci، N. meningitidis، E. coli and; Group A streptococcal polysaccharide antigens (Cusabio company; Austria liscence، China، ELISA) was searched in synovial samples (negative smear and culture). p value <0. 05 was considered valuable. Septic arthitis was diagnosed in 34. 5%; that included positive culture or gram staining in 15%، positive rapid antigen test (LPA) in 5. 7%، positive group A streptococcal polysaccharide antigens in 3. 8% of cases with negative results for other tests. Septic arthitis was diagnosed in 34. 6% of cases. Only 15% of cases had positive culture or gram stain (mainly S. aureus، S. pneumonis)، 5. 7% were diagnosed by rapid antigenic tests (LPA) and group A streptococcal polysaccharide antigens (ELISA) test was positive in 3. 8% of the remaining cases (negative smear and culture). By addingthenew diagnostic methods to the conventional culture tests for detecting common bacterial antigens (especially streptococcus)، the role of infectious organisms in evolution of acute arthitis would be elucidated better. Streptococcal polysaccharide antigens in synovial fluid are not defined by the immune system. The irreversible cardiac، renal، and neurologic complications are probable. Optimal treatment of proved streptococcal cases is recommended.

Diagnosing the etiologic causes for septic arthritis is very important. The main goal of study was to determine the group A streptococcal polysaccharide antigens in synovial fluid of patients with arthritis. A cross sectional study was performed upon 52 cases with acute mono arthritis in Hazrat-e-Rasool hospital in Tehran; Iran (2010-2012). Techniques used were: Gram stain/culture and rapid antigen tests (LPA) for H. influenza، S. pneumonia، group B streptococci، N. meningitidis، and E. coli and for Group A streptococcal polysaccharide antigens (Cusabio company; Austria license، China، ELISA) were searched in synovial samples (negative smear and culture). P value <0. 05 was considered valuable. Septic arthitis was diagnosed in 34. 5% (including positive culture or gram staining in 15%، rapid antigen test (LPA) in 5. 7%)، and positive group A streptococcal polysaccharide antigens was observed in 3. 8% of cases with negative results for other tests. Septic arthitis was diagnosed in 34. 6% of cases. Also 15% of cases had positive culture or gram stain (mainly S. aureus، S. pneumonis)، 5. 7% were diagnosed by rapid antigenic tests (LPA). Group A streptococcal polysaccharide antigens (ELISA) test was positive in 3. 8% of remaining cases (negative smear and culture). By adding the new methods of searching for the common bacterial antigens (especially streptococcus) to the conventional culture tests، the role of infectious organisms in evolution of acute arthitis would be elucidated more clearly. Streptococcal polysaccharide antigen in synovial fluid is not defined by immune system. The irreversible cardiac، renal، neurologic complications are probable. Optimal treatment of the proved streptococcal cases is recommended.

Ventilator associated pneumonia (VAP) is one of the most common nosocomial infections among patients in Intensive Care Unit (ICU)، which has high mortality rate. Among the common agents، Pseudomonas aeruginosa (P. aeruginosa) is the most common causative agents of VAP incidence and resistance to a wide range of antibiotics is increasing. The aim of this study was to assess the prevalence of P. aeruginosa and its drug susceptibility pattern.

This sectional survey has carried out for a year on ICU patients of Ayatollah Kashani hospital who received mechanical ventilation during Oct 2010 to Oct 2011. Sixty eight samples of endotracheal tubes were collected from the patients with signs of pulmonary infection which included fever، purulent secretions، and leucocytosis. Samples were cultured and strains isolated were identified by microbiological standard methods. Antibiotic susceptibility testing was performed on isolates using disc diffusion method and results were interpreted using Clinical and Laboratory Standards Institute guidelines. Antibiotics were grouped into the 4 following categories: 1) Cephalosporins (Ceftazidime، Cefepime)، 2) Fluroquinolones (Ciprofloxacin)، 3) Aminoglycosides (Gentamycin، Tobramycin، and Amikacin) and 4) Carbapenems (Imipenem).

Out of 68 endotracheal samples، VAP was confirmed in 46 cases (67. 7%) of these patients. The most common microorganism recovered was P. aeruginosa (15 cases، 32. 6%)، others were included: Methicillin-resistannt Staphylococcus aureus or MRSA (8 cases، 17/4%)، Klebsiella pneumonia (10 cases، 21/7%)، Escherichia coli (7 cases، 15. 2%)، Enterobacter (3 cases، 6. 5%)، Acinetobacter (2 cases، 4. 3%) and 1 case of Citobacter (2. 3%). 75% of P. aeruginosa isolated were MDR (resistant to ≥3 classes of antibiotics) and 50% of isolates were resistant to all classes of antibiotics.

Due to the increasing prevalence of Pseudomonas MDR، developing strict protocols to prevent increase in drug resistance bacteria appears to be necessary.

Percutaneous Endoscopic Gastrostomy (PEG) is the standard method for enteral feeding in patients predicted to require long-term enteral nutrition because of dysphagia. The aim of this study was to assess the complications of percutaneous endoscopic gastrostomy performed using the pull technique. Between January 2011 and December 2011، 74 patients underwent percutaneous endoscopic gastrostomy using the pull-through technique at Hazrat Rasoul Akram hospital. We analyzed the clinical characteristics of the patients related to the development of complications in a retrospective and cross-sectional study. Peritonitis، abscess، septicemia and bleeding were defined as major complications. Tube-related problems، including dislodgment، obstruction، leakage، vomiting and infection، were classified as minor complications. Patients had mean age of 60+/-21 (range: 5-90 years of age). Fifty four percent of them were females (n=40) and 46% were males (n=43). The most common indication for PEG was neurologic disorders in 73% patients. There was an overall complication rate of 18. 9%. The rates of major، minor and late complications were 2. 8% 14. 9% and 1. 4%، respectively. The mean time of complication after PEG insertion was 78. 85 ± 107. 13 days and 84. 6% of them occurred during three months. There was no difference between mean age and sex of patients with and without complication. There was no relationship between age، sex، underlying diseases and duration of hospital stay before PEG insertion and incidence of PEG complications. FPG is a safe method with low complication rate for constructing long-term enteral access in patients although it has a number of complications، though most of them are minor. Patients must therefore be informed that this is not a complication-free procedure.

Tuberculosis (TB) is one the oldest known diseases in human. According to its high prevalence in Iran، using a diagnostic procedure with more rapid result than culture، more sensitive and specific than smear and near to culture can help us to diagnose and treat the disease rapidly and accurately، and thus control it in the community. So we decided to evaluate PCR for the diagnosis of Tuberculosis in Broncho-alveolar Lavage (BAL) and compare it with smear. Patients who were admitted at Hazrat Rasoul Akram Hospital during 2 years of 2010-11 with the impression of tuberculosis and underwent bronchoscopy were included. Their BAL was sent for smear، culture and PCR for tuberculosis diagnosis. Data were analyzed by mean and standard deviation and p Value under 0. 05 was considered significant. Forty seven patients with probable pulmonary tuberculosis underwent bronchoscopy. BAL cultures were positive in 6 (12. 8%) patients، smears in 5 (10. 6%) patients and PCR in 3 (6. 4%) patients. According to this result smear had 83% sensitivity، 100% specificity، 100% PPV and 98% NPV. However PCR had 50% sensitivity، 100% specificity، 100% PPV and 93% NPV. Although PCR is a rapid and new tool for TB diagnosis، smear- which is an older way- is simpler has lower cost and is feasible in all points of Iran and still is a better method for TB diagnosis.

There are many published international recommendations and guidelines for the management of Invasive Fungal Infections (IFIs). It is very important to develop Iranian recommendations to implement those guidelines in a daily routine practice in Iran considering the local specifications. This was the objective of this meeting, which was held on November 3rd, 2011 in Tehran. 17 Iranian scientific leaders met and reviewed all the available published International Guidelines for management of IFIs in different groups of patients. This was followed by an open discussion to develop local recommendations for appropriate implementation of International Guidelines using the available treatments in Iran. This review shows the outcome of this meeting. We believe that, putting these recommendations into practice may lead to better results of the management of cases with IFIs.

The nature of changes in the lipid profile caused by an acute infection is controversial. In this study we compared concentrations of plasma lipids in 70 septic and non-septic patients in ICU and studied the prognostic impact of cholesterol, LDL-C, HDL-C and triglyceride. From March 2009 to February 2010, all patients consecutively admitted to the Intensive Care Units of Rasoul Akram University Hospital, Tehran, Iran, were studied. Each person was examined for signs and symptoms of infection during hospital stay. Patients were classified as suffering from sepsis or not at the first 24 hours of admission. Descriptive results of continuous variables were expressed as mean (±SD). The associations between factors were analyzed by t-test and between factors and prognosis by χ2 test when appropriate The study population included 28 males and 42 females with mean (± standard deviation) age of years 73.6 ± 15.7 that 29 of them were in sepsis group and 41 of them in non-sepsis group. There wasn’t any relationship between sex and mortality (p= 0.34), although by increasing age mortality leveled out (r=-0.58, p= 0.04).The concentrations of total cholesterol (89.3 ± 33.6 vs 100.7 ± 25.3 mg/dl), HDL (20 ± 5.6 vs 30.2 ±8.7 mg/dl), and LDL (61.5 ± 18.7 vs 70.6 ± 14.5 mg/dl) showed significantly lower values in septic group but no difference could be find in triglyceride level (177.7 ± 28.7 vs 182.8± 45.9 mg/dl). In septic group the initial and second levels of cholesterol were considerably higher in patients who died than those who survived (101.6 ± 37.5 versus 69.4 ± 8.3 and 103.2 ± 23.4 versus 79.4 ± 47 respectively, p=0.00). In ICU setting, measurement of cholesterol values has been shown to improve risk prediction, and inclusion of lipid values in clinical risk assessment scores of critically ill patients has been advocated. Further understanding of the alterations in lipid metabolism may have therapeutic implications in treatment of sepsis.

Diabetic foot infection is a debilitating disease that requires prompt diagnosis and treatment. In this study, we assessed inflammatory markers; serum Procalcitonin (PCT), c-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leukocyte counts in two groups of patients with infected and non-infected diabetic foot ulcer.Patients and A descriptive cross-sectional study was carried out on diabetic patients during 18 months in Firoozgar Hospital. Patients were divided in two groups according to Infectious Disease Society of America (IDSA) guideline for diagnosis and treatment of diabetic foot infections. Blood samples were drawn from venous lines for measurement of complete blood count (CBC), ESR, CRP, and PCT. Diagnostic values of serum PCT Levels were determined by immunoluminometric assay. SPSS version 15.0 software was used for analysis. Sixty adult patients were considered for this study. Thirty patients with infected ulcer with mean age of 57.5× 2.09 years and 30 with non- infected ulcers with mean age of 61.1± 1.9 years were evaluated.Patients with infected ulcers had significantly elevated levels of CRP, ESR and leukocyte counts in comparison with the non- infected ulcers. Serum PCT levels did not differ between the two groups. Our study suggests CRP, ESR and Leukocyte counts can be used to diagnose of infected ulcers. The role of PCT in localized infections should be determined in further studies.

Triggering receptors expressed on myeloid cells i.e soluble triggering expressed on myeloid cells-1 (STREM-1) is inducible on monocyte/macrophages and neutrophils and accelerates tissue destruction by propagating inflammatory responses in disease related to bacterial infections. The aim of this study was to investigate the role of STREM-1 in the synovial fluid to identify septic arthritis from aseptic ones. A cross sectional study (2007-2009) was conducted in the Pediatric & Orthopedic wards of Hazrat-e-Rasool Akram hospital, Tehran. Synovial fluid was aspirated in 53 cases with arthitis and searched for diagnosis of bacterial arthritis by conventional diagnostic tests. About 0.5-3cc of synovial fluid was stored at -70 °C, and quantification of STREM-1 was done in 53 synovial fluid samples (Quantikine, R&D systems, USA) by EIA; results were compared between septic and aseptic arthritis. Septic arthritis was detected in 49% (26/53) and aseptic arthritis in 51%(27/53). Positive synovial fluid culture was detected in 20.3%, and positive latex particle agglutination for bacteria was found in 8.5%. Positve direct smear was obtained in 10.5% of the cases.Cut off level 825 pg/ml for SF-STREM-1 yielded 50% sensitivity, 70% specificity, 64% Positive Predictive Value (PPV), and 64%, Negative Predictive Value (NPV). Poor agreement was seen between SF -STREM-1 levels and positive culture (p value: 0.037; Kappa=0.28). The area under the ROC curve for discriminating between septic and aseptic arthitis was 0.603 (95% CI; 0.757–0.448, p = 0.1). SF-STREM-1 level with cutoff 825pg/ml had 50% sensitivity, and 70 % specifity in discriminating between proved cases with septic arthitis from aseptic ones. Searching for bacterial antigens in synovial fluid (Latex Particle Aagglutination test) and synovial fluid -STREM-1 level could potentially assist clinicians in better diagnosis of septic arthitis if added to the conventional tests including smear and routine analysis of synovial fluid. It might prevent unnecessary empiric antibiotic theray in children with arthritis. In clinical decision making; randomized studies on the potential synovial fluid - STREM-1 -level guided antimicrobial therapy in bacterial arthritis would be useful.

Atypical clinical manifestations and radiologic images of pulmonary tuberculosis are common in elderly. To investigate the differences in the clinical, radiologic and laboratory features of pulmonary and pleural tuberculosis in older patients, as compared to younger patients. The medical records of patients with documented pulmonary tuberculosis in Rasoul-e-Akram hospital from 2005 through 2010 were analyzed. Data included sex, age, medical comorbidities, symptoms and signs, laboratory data, radiographic findings, tuberculin skin test (TST) and sputum smears and bronchoalveolar lavage (BAL) for AFB results. Statistical significances were analyzed by student t test and chi2 test. Among 285 patients with documented tuberculosis, 126 were 65 years of age and older, and 159 under 65 years of age. A lower prevalence of fever, night sweating, hemoptysis, anorexia, pleuritic chest pain, cavitary lesion in upper lobes, positive TST and positive acid fast bacilli in sputum and BAL were detected among older patients (p<0.05). In addition, the older patients had a greater prevalence of dyspnea (p<0.001) and some comorbidities, such as diabetes mellitus, COPD, and renal failure (p<0.05). This study showed the main differences of pulmonary tuberculosis in the elderly, compared to young patients that should be considered during the diagnostic assessment.