فهرست مطالب mir mohammad miri

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality worldwide, characterized by a complex cascade of pathophysiological events that can result in diverse clinical outcomes ranging from mild cognitive impairments to severe disability. The pathophysiology of TBI involves a complex interplay of cellular and molecular events that contribute to secondary brain injury and neurodegeneration. Predicting neurological outcomes in TBI patients is crucial for guiding treatment decisions and enhancing patient care. Traditional methods of assessing TBI severity and prognosis have limitations in accurately predicting long-term outcomes. In recent years, microRNAs (miRNAs) have emerged as promising biomarkers for evaluating TBI severity and prognosis. MicroRNAs are small non-coding RNA molecules that regulate gene expression and have been implicated in various physiological and pathological processes, including neurodevelopment, neuronal function, and neurodegeneration. Several studies have identified specific miRNAs as potential biomarkers for assessing TBI severity and predicting patient outcomes. MiR-21, miR-155, miR-146a, and miR-124 are among the most studied miRNAs in the context of TBI biomarkers. Elevated levels of these miRNAs in blood, cerebrospinal fluid, and brain tissue have been associated with TBI severity, neuroinflammation, and poor neurological outcomes. Understanding the role of miRNAs in TBI pathophysiology can provide valuable insights into the mechanisms underlying neuroinflammation and neurodegeneration. Furthermore, miRNA signatures have shown promise in distinguishing between different TBI phenotypes, such as mild, moderate, and severe TBI, and predicting long-term cognitive deficits and functional impairments in TBI survivors. This suggests that miRNAs could serve as valuable tools for improving TBI patient care and outcomes.[1,2] Role of miRNAs in TBI PathophysiologyMicroRNAs play a crucial role in modulating neuroinflammatory responses and neurodegenerative processes in traumatic brain injury. Dysregulated expression of specific miRNAs contributes to secondary brain injury, neuronal apoptosis, neuroinflammation, blood-brain barrier disruption, neurodegeneration, and cognitive impairments following TBI.[2]Neuroinflammation is a hallmark feature of TBI, characterized by the activation of microglia, astrocytes, and peripheral immune cells in response to brain injury. Dysregulated expression of specific miRNAs has been implicated in modulating neuroinflammatory responses following TBI. For example, miR-155 has been shown to promote microglial activation and pro-inflammatory cytokine production, exacerbating neuroinflammation and neuronal damage. In contrast, miR-146a acts as a negative regulator of inflammatory signaling pathways, attenuating neuroinflammatory responses and promoting neuroprotection in TBI models. The dynamic interplay between miRNAs and inflammatory mediators in the injured brain highlights the intricate regulatory mechanisms underlying neuroinflammation in TBI.[3]Neuronal cell death and neurodegeneration are other common pathological features of TBI, contributing to long-term cognitive impairments and functional deficits. Dysregulated expression of miRNAs has been associated with apoptotic cell death, synaptic dysfunction, and axonal injury in TBI. MiR-21, for instance, has been shown to promote neuronal apoptosis and glial scar formation following brain injury, exacerbating neurodegenerative processes. In contrast, miR-124 plays a neuroprotective role by regulating neuronal differentiation, synaptic plasticity, and axonal regeneration in response to TBI. The complex interplay between miRNAs and neurodegenerative pathways underscores their potential as therapeutic targets for mitigating neuronal damage and promoting recovery after TBI.[3]Targeting dysregulated miRNAs represents a promising therapeutic strategy for modulating neuroinflammation and neurodegeneration in TBI. MiRNA-based interventions, such as antagomirs or mimics, offer potential avenues for restoring miRNA homeostasis and promoting neuroprotective effects in the injured brain. Future research efforts should focus on identifying specific miRNA targets involved in TBI pathophysiology, elucidating their functional roles in neuroinflammation and neurodegeneration, and exploring innovative therapeutic approaches for TBI management. Collaborative initiatives between researchers, clinicians, and pharmaceutical companies are essential for translating miRNA research into clinical applications and improving outcomes for TBI patients.[4] MiRNA Biomarkers for Predicting Neurological RecoveryThe utilization of miRNA biomarkers in clinical practice holds the potential to revolutionize prognostication and treatment decision-making in TBI. By pinpointing specific miRNA signatures linked to neurological outcomes, clinicians can categorize patients based on their likelihood of developing complications, cognitive impairments, or disability post-TBI. Numerous studies have documented distinct expression patterns of miRNAs in TBI patients with varying levels of cognitive impairment, functional disability, and neurobehavioral deficits. MiR-21, miR-146a, and miR-132 have emerged as promising biomarkers for forecasting neurological recovery and functional outcomes in TBI. The integration of miRNA profiles with clinical evaluations and neuroimaging data has the potential to enhance the precision of outcome predictions and facilitate personalized treatment approaches for TBI patients. Further research is imperative to validate miRNA signatures, establish standardized protocols for miRNA profiling, and implement predictive models that amalgamate clinical, imaging, and molecular data to enhance prognostication and treatment strategies for TBI patients. Future research endeavors should prioritize the validation of miRNA biomarkers in extensive prospective cohorts, elucidate their mechanistic roles in TBI pathophysiology, and incorporate them into multidimensional prognostic models for tailored patient care. Collaborative initiatives involving researchers, clinicians, and industry partners are paramount for translating miRNA research into clinical applications and enhancing outcomes for TBI patients.[5,6] Challenges and Opportunities for Advancing MiRNA Biomarker in TBIDespite the growing interest in miRNA biomarkers for TBI, several challenges need to be addressed before their clinical implementation. Standardization of sample collection and processing protocols, validation of miRNA signatures in large patient cohorts, and integration of miRNA data with other clinical variables are critical steps towards translating miRNA research into clinical practice. Additionally, the lack of standardized protocols for miRNA profiling and validation poses obstacles to comparing results across different studies. The heterogeneity of TBI phenotypes and patient populations further complicates the identification of robust miRNA signatures predictive of neurological outcomes.[4,5] Despite the challenges, there are promising opportunities for advancing miRNA biomarker research in TBI. Technological advancements in high-throughput sequencing and bioinformatics tools enable comprehensive profiling of miRNA expression patterns in TBI patients. Collaborative efforts among researchers, clinicians, and industry partners can facilitate the validation of miRNA biomarkers in large multicenter cohorts, enhancing their clinical utility. Integrating miRNA profiles with other omics data, neuroimaging findings, and clinical assessments holds potential for developing multidimensional prognostic models for personalized TBI management.[6] ConclusionFuture research directions should focus on standardizing methodologies for miRNA biomarker discovery, validation, and implementation in TBI clinical practice. Large-scale prospective studies are needed to validate miRNA signatures associated with specific TBI outcomes and refine predictive models for patient stratification. Incorporating miRNA biomarkers into existing prognostic tools and treatment algorithms may improve risk assessment, therapeutic decision-making, and long-term outcomes for TBI patients. Collaborative initiatives aimed at translating miRNA research findings into actionable clinical insights are essential for realizing the full potential of miRNA biomarkers in TBI management.

Mineral assemblage of metamorphic rocks forms by various factors including temperature, pressure, protolith chemical composition, and fluids. Although, P-T variation is the main factor controlling mineralogical evolution and assemblages, chemical differences of protoliths and metamorphic fluids also play an important role in the formation of final mineral assemblages (e.g. Spear, 1993). Therefore, mineral assemblages can be used in the study of thermodynamic and chemical conditions of metamorphic events. The studied area is located in the northwest of Sarve-Jahan village. For the purpose of the present paper, we investigate the metamorphic evolution of Sarve-Jahan schists (Zanjan province) and the effect of important factors on the formation of their mineral assemblages are through calculating phase diagrams. The study area is located in the northwest of Sarve-Jahan from Soltanieh structural zone and hosts Upper Neoproterozoic - Lower Cambrian schists (Fig. 1). The Soltanieh strip is a narrow and long structural strip trending northwest-southeast with a length of over 150 km and a width of 10-12 km. This belt as an uplifted tectonic bedrock lies in the structural zone of Central Iran. It comprises a complete set of thick clastic, carbonate and pyroclastic sediments (Kahar, Bayandor, Soltanieh, Barut and Lalon Formations) (Stöcklin and Eftekharnezhad, 1969) belonging to Precambrian-Paleozoic.. In the northwest of Sarve-Jahan and the vicinity of Sarve-Jahan granite, there is a metamorphic complex trending northwest-southeast, composing pelitic schists, metacarbonate (chalk schist) and sandstone (quartz schist and quartzite). The complex belongs to the Kahar Formation (Stöcklin and Eftekhar-nezhad, 1969; Babakhani and Sadeghi, 2004). In the southwest of metamorphic complex, there is a row of slates gradually replaced by phyllites and schists towards the northeast. The exposed Mesozoic deposits in the studied area include the sediments of Shemshak Formation and Lar limestones (Fig. 1) (Babakhani and Sadeghi, 2004, Stöcklin and Eftekhar-nezhad, 1969). Tertiary deposits include a sequence of detrial sediments as well as igneous and volcanic rocks (Stöcklin and Eftekhar-nezhad, 1969).

Seventy microscopic thin sections were studied by a polarizing microscope with transmitted light. Five samples with the highest number of phases in equilibrium were selected for microprobe analyze. The samples were analyzed in Iranian Mineral Processing Research Center using a CAMECA model SX 100 device with an electron beam acceleration voltage of 15 kv, current intensity of 3 nA and analysis time of 40 seconds for each point. Whole-rock compositions of these samples, also were determined by X-ray Fluorescence (XRF) spectroscopy method using a PHILIPS PW1480 instrument in the Kansaran Binaloud laboratory.

Petrography:

The studied rocks include garnet and staurolite porphyroblasts lie in a well-oriented matrix composed of biotite + muscovite + chlorite + plagioclase + quartz. Three phases of deformation (D1, D2, D3) and two phases (M1, M2) of metamorphism occurred in the metamorphic rocks. The M1, could be related to the D1 and characterized by garnet + staurolite + chlorite + biotite + muscovite + plagioclase + quartz assemblage. The M2, could occur in association with D2 and formed chlorite + biotite2 + muscovite2 + quartz. The third deformation phase (D3) caused crenulation cleavage on D2 schistosity but with no new mineral phase. Garnet and staurolite porphyroblasts formed during M1. Retrogressive metamorphism replaced these minerals with chlorite and muscovite in their rims. Whole-rock and mineral chemistry The samples studied contain high SiO2, Al2O3 and K2O corresponding to a Fe-rich shale protolith (Table 1). The biotites and white-micas have high annite and muscovite end-members, respectively. Garnets and staurolites are also Fe-rich and plagioclase are of albite to oligoclase compositions (Table 2).

Thermobarometry Various thermobarometry calculations based on garnet-biotite (Bhattacharya et al., 1992), muscovite-chlorite (Vidal and Parra, 2000) and garnet-plagioclase-biotite-quartz (Hoisch, 1990) methods resulted c.a. 600 °C and 5-7 kbar for the M1 and 500°C and 6 kbar for the M2.

Equilibrium phase diagram:

The equilibrium phase diagrams were calculated using GeoPs software (version 3.3) and Bi(w), Chl(W), Crd(W), Ctd(W), St(W), Gt(W), Mica(W), Opx(W), melt(W) and Fsp(C1) (Holland and Powell, 2003; White et al, 2014) solid solution models for average composition of the studied samples. The P-T pseudosection diagram (Fig. 5) shows that the M1 assemblage garnet + staurolite + biotite + muscovite + chlorite + quartz + plagioclase is stable in 550 – 650 °C and 5 – 7.2 kbar, while the assemblage biotite2 + muscovite2 + chlorite2 + quartz + plagioclase corresponding to M2, is stable in T<550 °C and P<5 kbar. The calculated isopleths for pyrope in garnet and phlogopite in biotite intersect at the stable filed of M1 assemblage (Fig. 6) confirming the thermobarometry results.

Protolith composition:

The Mg# [Mg# = (MgO/MgO+FeO)] versus T variations phase diagram (Fig. 7) shows that the stability of garnet and staurolite is affected by Mg and Fe contents of the protolith. They leave the system with increasing Mg# at constant T. In other words, the high FeO contents of the Sarve-Jahan schist protolith had a significant role in the formation and the stability of the peak metamorphism mineral assemblage.

Fluid composition:

The CO2 contents of metamorphic fluids is important in the stability of minerals (e.g. Miri et al., 2023). A T-XCO2 phase diagram was calculated for the sample assuming a H2O-CO2 fluid to investigate the role of CO2 in the metamorphic of the samples (Fig. 8). The diagram indicates that the M1 mineral assemblages was stable at XCO2 < 0.3, but the M2 was stable only in the presence of pure H2O fluid.

Microstructures show that the deformation phases (D1, D2, and D3) and the two metamorphic phases (M1 and M2) occurred in the area. The M1 and M2 were contemporaneous with D1 and D2, respectively, while D2 was not in association with a metamorphic phase.The mineral assemblage garnet + staurolite + chlorite + biotite + muscovite + plagioclase + quartz formed in M1 and peak of metamorphism (amphibolite facies) and biotite2 + muscovite2 + chlorite2 + quartz + plagioclase formed in the retrogressive metamorphism M2 phase (greenschist facies).The traditional (mineral pairs) and modern (phase diagram) thermobarometry calculations show obtain 550 – 650 °C and 5 –7 kbar for M1 and < 500 °C and < 5kbar for M2. On this basis, a clockwise P-T-t path can be considered for metamorphism of the Sarve-Jahan schists. Which could have occurred in a subduction-collision tectonic site.The calculated T-Mg# and T-XCO2 phase diagrams show that the composition of the protolith and the metamorphic fluid played a significant role in the minerals assemblage event occurring during peak metamorphic conditions.

The Qori metamorphic complex in the northeast Neyriz (Sanandaj-Sirjan zone) formed due to the different metamorphic phases during the Jurassic to Cretaceous as a result of the subduction of the Neotethys oceanic crust beneath the Iran microplate. The whole-rock compositions revealed that some of the complex units formed from the metamorphism of basic protoliths. Petrographic investigations showed that the metabasites contain assemblage actinolite + zoisite + plagioclase + chlorite + epidote + quartz ± titanite in the lowest metamorphic grade (green schist facies) that was replaced by hornblende + plagioclase + garnet + clinopyroxene + quartz ± titanite assemblage at the peak of the metamorphism (lower granulite facies). Based on the thermodynamic phase diagrams (pseudosection) calculated for these rocks, the metamorphism at the green schist facies occurred at T < 550 C° and P < 5 kbar, while the peak condition occurred T and P 640 to 750 C° and 6.5 - 10 kbar, respectively. The other phase diagrams indicate that the low MgO content in the protolith and CO2</sub> content in the metamorphic fluid played an important role in the formation and stability of the metamorphic assemblages observed in the metabasites of the Qori metamorphic complex.

The role of caffeine as a brain stimulant in improving the respiratory characteristics of patients under mechanical ventilation is unclear. This study aimed at determining the effect of oral caffeine in helping to release (Liberation) from the ventilator in intubated patients under mechanical ventilation admitted to the intensive care unit.
General ICU patients with more than 48 hours of dependency on a ventilator were randomly divided into two groups. The intervention group received 200mg caffeine tablets twice a day through a gastric tube, while the control group received a placebo of the same amount. Every day, patients were assessed for the likelihood of being disconnected from the device. If their clinical condition was deemed suitable, the device mode was switched to spontaneous, and their Rapid Shallow Breathing Index (RSBI) was calculated. Based on this information, a decision was made regarding whether to proceed with weaning.
Caffeine use in ICU patients significantly reduced the airway resistance index of patients (P <0.05). However, although this drug reduced the length of hospital stay in the ICU and the duration of intubation of patients, these changes were not statistically significant (P> 0.05).
Caffeine may improve respiratory status and reduce the duration of intubation and hospitalization in the ICU.

Dear Editor Traumatic brain injury (TBI) is a common cause of death and disability, with long-term consequences including cognitive impairment, emotional disturbances and physical disability. Prognosis prediction in TBI patients is critical for guiding treatment decisions and improving patient outcomes. The Glasgow coma scale (GCS) and Glasgow outcome scale (GOS) are useful tools to assess and monitor TBI patients, but other factors such as age, motor component of GCS, and type of injury also significantly influence clinical outcomes. With the advent of artificial intelligence (AI), there is growing interest in using machine learning algorithms to predict prognosis in TBI patients.[1] Here we discuss the harnessing of AI in prognosis prediction for TBI patients, as well as its potential benefits, disadvantages, challenges and predicted future directions. Current state of AI in prognosis prediction for TBI patientsReflecting on large bodies of data (clinical, radiographic and laboratory), AI has shown promise in predicting prognosis in TBI patients. Machine learning algorithms (MLA) can identify patterns in data that may not be immediately apparent to human clinicians, allowing for more accurate predictions of patient outcome. There are several studies that have used MLA to develop diagnostic systems for TBI and predict patient outcomes. These studies have used various clinical inputs such as vital signs, electroencephalography (EEG), hospital volume, Charlson comorbidity index and length of stay to develop machine learning (ML) models.[2] In a study conducted by Mawdsley et al, the effectiveness of ML models in predicting psychosocial aspects of TBI cases was systematically reviewed. The study included nine studies with eleven types of ML used to predict various outcomes of traumatic brain injury, concussion and psychosocial outcomes. The results indicated that while these models were able to develop predictive models successfully, there is insufficient evidence to consider ML algorithms as a dependable tool for clinical decision-making.[3] Alanazi et al., conducted a review in 2017 to assess the effectiveness of ML models in predicting patient outcomes for various disorders. The study revealed that AI has the potential to create several promising models that can predict outcomes using clinical, demographic, and imaging data. However, there are still limitations in applying these models in clinical settings. Therefore, further research is necessary to improve the reliability of these models in the future.[4] Potential benefits of AI in prognosis prediction for TBI patientsThe use of AI in prognosis prediction for TBI patients has several potential benefits. First and foremost, it can provide clinicians with more accurate and reliable predictions of patient outcomes, allowing for more informed treatment decisions. This can lead to improved patient outcomes and reduced healthcare costs. AI can help identify patients who are at high risk for poor outcomes, allowing for early interventions that may improve their prognosis, or early decision making around withdrawal of treatment. For example, if an algorithm predicts a patient is at high risk of adverse effects from an intracranial hemorrhage, clinicians can perform early surgical interventions or administer medications early to prevent further bleeding. In addition, AI can help identify patients who are likely to have favorable outcomes, or who do not require intervention, which allows for more efficient distribution of healthcare resources. For example, if an algorithm predicts a patient is likely to have a good outcome, they may not require intensive care unit (ICU) admission, or may not require prolonged rehabilitation services. Finally, AI can also help reduce the workload of medical professionals by performing repetitive tasks such as data entry and analysis. This can free up time for physicians and nurses to focus on providing high-quality care to patients.[1,5] Potential disadvantages of AI in prognosis prediction for TBI patientsThere are several potential disadvantages of using AI in predicting the clinical outcomes of patients with TBI.  AI algorithms rely on large amounts of data to make accurate predictions. However, there may not be enough high-quality data available to train AI models effectively. Data entry relies on human factors and may be poorly or incorrectly entered, making errors possible. Also, AI algorithms may be biased if the data used to train them is not representative of the population being studied. For example, if the data used to train an AI model on TBI outcomes comes from a specific hospital or region, the model may not generalize well to other populations. AI models can be complex and difficult to interpret. Clinicians may struggle to understand how the model arrived at a particular prediction, which could lead to skepticism or mistrust of the technology. Finally, there are ethical considerations around the use of AI in healthcare. If an AI model predicts that a patient has a poor prognosis, this could lead to decisions about end-of-life care, which may go against the patient's wishes or values. Clinicians must carefully consider the potential risks and benefits of using AI in clinical decision-making.[1,5] Future DirectionsThe future of prognosis prediction in TBI patients using AI is promising. However, there are several challenges that must be addressed. One challenge is the lack of standardized data collection and reporting. To develop accurate algorithms, large amounts of high-quality data are required. However, there is currently no standardized way to collect and report TBI data, making it difficult to develop accurate, widely transferable algorithms. Another challenge is the need for validation studies. While initial research has shown promising results, further validation studies are needed to confirm the accuracy and reliability of AI algorithms in predicting TBI prognosis,[3,4] as well as ensuring safety in clinical practice.[1,6]With the increasing availability of electronic health records and the development of advanced AI algorithms, there is potential for more accurate and reliable predictions of TBI outcomes. AI can help identify patterns and correlations in patient data that may not be easily recognizable by human clinicians, leading to more personalized and effective treatment plans, however, there is the challenge of integrating AI into clinical practice. Clinicians must be trained on how to interpret and use AI predictions in their decision-making processes. This will require collaboration between clinicians and AI experts to develop user-friendly interfaces that can be integrated into clinical workflows. ConclusionThe reliability of prognosis prediction in TBI patients using AI depends on the quality and completeness of the data, the type of algorithm used and the level of validation testing performed. Conclusions surrounding the selection of optimal clinical or para-clinical features and the most precise machine learning model for predicting outcomes in TBI patients is still inconsistent. However, early studies have shown that AI algorithms can accurately predict mortality and functional outcomes in TBI patients by analyzing large amounts of patient data, including clinical, radiographic, and laboratory data. Therefore, further validation studies are needed to confirm the accuracy and reliability of AI algorithms in predicting TBI prognosis before they can be integrated into clinical practice. With continued research and collaboration between clinicians and AI experts, the use of AI in prognosis prediction for TBI patients has the potential to revolutionize TBI care and improve patient outcomes.

Colistin is a drug of choice against multidrug-resistance (MDR) bacteria. The most important side effect of colistin is nephrotoxicity, observed in 20 - 54% of patients. According to the studies that examined its antioxidant effect, it can reduce the kidney toxicity of various drugs, including colistin.

This study aimed to investigate melatonin’s effect on reducing colistin-induced kidney toxicity to use this drug with fewer complications.

This double-blind, randomized clinical trials with two groups involved 56 critically ill adults infected by MDR bacteria. The intervention group received 3 mg of oral melatonin simultaneously with intravenous colistin, which continued until the end of the treatment. The control group received placebo orally with IV colistin. We measured urine volume, blood creatinine, and BUN daily and determined the patients with renal failure using the KDIGO guideline. STATA software analyzed data with a P-value of less than 0.05 as the significance level.

Data obtained from recipients were analyzed for age (P-value = 0.357), gender (P-value = 0.945), weight (P-value = 0.438), APACHE score (P-value = 0.162). We did not observe significant difference in AKI criteria between the two groups. Compared to the control group, melatonin did not decrease blood creatinine (P-value = 0.110) and BUN (P-value = 0.567) and, made no change of urinary volume (P-value = 0.913). There was no decrease in kidney failure in the intervention group compared to the control group. As a result, we did not find a significant difference in outcome of the two groups.

We did not reveal any significant difference in the AKI criteria including blood creatinine,BUN,anddaily urinevolume with the addition of melatonin in participants receiving colistin; However, no complication was observed in the intervention group who received melatonin.

 Infectious diseases are associated with thyroid autoimmune disorders, mainly. Meanwhile, thyroid gland function as a risk factor for infectious diseases is a challenging debate topic that needs more evaluation. Considering the high burden of hypo and hyperthyroidism in many regions of the world and the consequences of these disorders on different aspects of human health, evaluating and screening high-risk populations and treating patients is of great importance. In the present research, we investigated any association between thyroid dysfunction and asymptomatic bacteriuria in women of reproductive and postmenopausal age.

 The study was performed for six years (between 2015-2021) in Tehran, Iran. Our study enrolled 188 women of reproductive and postmenopausal age with and without asymptomatic bacteriuria. All participants' thyroid stimulating hormone (TSH) and free T4 levels were evaluated. The association between thyroid dysfunction and asymptomatic bacteriuria was assessed.

 The mean level of TSH in all culture-positive samples was 2.39, while it was 3.11 in culture-negative samples (P value < 0.05). The mean TSH level was 2.4 and 2.3 in Escherichia coli and Non- E. coli positive urine cultures, respectively (P value= 0.67). Asymptomatic bacteriuria was significantly more common in patients with lower TSH levels. The mean level of free T4 in all participants was 8.21, with maximum and minimum levels of 12.3 and 4, respectively. Also, the mean level of free T4 in all culture-positive samples was 9.53, while 7.13 in culture-negative samples (P value=0.09). The mean free T4 level was 9.36 and 10.03 in E. coli and Non-E. coli positive urine culture respectively (P value= 0.35).

 Our study revealed a significant correlation between the population's TSH level and asymptomatic bacteriuria. Also, it showed no significant association between TSH level and any specific uropathogenic.

Road traffic accidents in Iran significantly contribute to morbidity and mortality, thereby profoundly impacting public health. According to 2019 World Health Organization (WHO) data, Iran ranks 130th out of 191 countries in traffic-related mortality rate due to accidents and impacts 21 per 100,000 individuals. In contrast, countries like Switzerland, Singapore, and Norway demonstrate admirable metrics by having less than 3 deaths per 100,000 individuals. Indeed, Iran's road traffic accident rate surpasses global benchmarks by 20%. Comprehensive studies undertaken within Iran have identified the primary contributors to road traffic accidents as: human error during driving, vehicular technical failures, suboptimal road infrastructure, and environmental conditions. Additionally, a scarcity of medical equipment and post-accident emergency medical care services exacerbate an already high mortality rate. An unfortunate reality is that road traffic accident-induced injuries rank among the top five causes of death in Iran, with highest number of fatalities recorded in 2004, accounting for 27,000 lives.[1,2]At the onset of the COVID-19 pandemic in Iran during 2020 and 2021, quarantine and travel restrictions led to a temporal decline in road traffic accidents (approximately 15,000 individuals annually). However, as 2022 witnessed a resurgence in intercity travel, the transient nature of this trend saw an escalation of accidents to over 19,000 (a 14.5% increase from the prior year) [Figure 1]. On average, 50 individuals were fatally injured on a daily basis due to road traffic accidents in 2022 (approximately 2 deaths per hour); which was amplified tenfold for those that were either injured or disabled. Yet the COVID-19 outbreak in 2020 and 2021 overshadowed road traffic accident data, and became the primary public health emphasis (prevention and treatment) during the pandemic. Despite a daily mortality rate of 50 individuals from road traffic accidents, a peak of over 500 daily COVID-19 deaths in Iran rendered the former public health concern all but inconspicuous. Certainly, such a disparity could be attributed to travel restrictions and the rapid escalation and unknown nature of the SARS-CoV-2 virus, the lack of vaccines and targeted treatments initially, or the extraordinary surge in mortality rates.[3,4]Fatalities from road traffic accidents historically have failed to evoke the same magnitude of public alarm as did the considerably higher mortality rates from COVID-19. Despite global initiatives that have substantially controlled death from COVID-19 (sometimes reaching zero in Iran), road traffic accident rates remain largely unchanged. This is a call to action for road traffic accident casualties to cease in Iran.  We urge Iranians to adopt vehicular safety behaviors (avoiding speeding, not wearing seat belts, reckless driving, drowsiness, and distractions) with the same vigor as pandemic precautions. We appeal to the Iranian Ministry of Roads and Urban Development and National Road Safety Commission along with automotive manufacturing sectors to work together and continue to prioritize and enhance efforts to address this escalating crisis. Envisioning a safer and traffic accident-free Iran remains a challenge, but is a challenge worth confronting.

 Vitamin D has neuroprotective and anti-inflammatory effects in stroke patients, but its effect on pro-inflammatory and inflammatory cytokines, especially IL-1, has been investigated in a few trials.

 This study aimed to determine the effect of prescribing a high dose of vitamin D on the anti-inflammatory parameters, short-term and long-term prognosis of patients with ischemic stroke.

 This randomized clinical trial was performed on 42 patients randomly divided into two equal groups of 21 in Imam Hussein Hospital. The patients were allocated through block randomization methods to receive 300,000 units of vitamin D (intramuscularly) or not receive it as a control group. Age, gender, and clinical and laboratory information were recorded. The stroke severity was calculated according to the National Institute of Health Stroke Scale (NIHSS) at the beginning of hospitalization and upon hospital discharge. The 3-month prognosis of the patients was recorded according to the Barthel criteria three months after the stroke. Vitamin D3 levels were recorded before and after injection, while the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were assessed on the first day and for 7 consecutive days after hospitalization. All statistical analyses were performed using STATA version 14. A P-value < 0.05 was considered significant.

 The mean age of the patients was 61.45 ± 4.74 years. There were 18 female (42.86%) and 24 male patients (57.14%). In the vitamin D group, the mean IL-1 decreased compared to before the intervention (-23.60 ± 103.83), but this decrease was not statistically significant (P = 0.070). In addition, the changes in IL-1 after the intervention were statistically different between the two groups (mean difference of -23.60 ± 103.83 in the vitamin D group vs. 15.96 ± 9.64 in the control group). The mean IL-6 decreased in both groups after the intervention compared to before, although these changes were not statistically significant (P > 0.05). In the group receiving vitamin D compared to the control group, the mean NLR decreased by about 2 units, the PLR decreased by about 10 units, and the NIHSS score decreased by about one unit during the study. However, these changes were not statistically significant (P > 0.05).

 A high dose of vitamin D can improve the NIHSS score and decrease IL-1 and IL-6, although these changes were not statistically significant. The mean NLR and PLR decreased after using high-dose vitamin D.

Migmatites are silisic rocks form in middle to high degree metamorphic territories, at lower to middle continental crust and through water producing reactions (Makrygina, 1977; Brown, 1979; Ashworth, 1985). During intrusion of Chah-Bazargan batholith in the Barrovian-type Qori-Neyriz regional metamorphic rocks at 170 Ma (Fazlnia, 2017), some pieces of these rocks were trapped in the magma and endured intense metamorphism and anatexis. They show stromatic and nebulitic magmatic structures. In the present study, the stable mineral assemblages, conditions, and factors affected partial melting in the Chah-Bazargan migmatites are investigated using phase diagrams and petrographic evidence.

The nebulitic migmatites representing the highest metamorphic degree and close and gradational relationships with peraluminous granites in the area were sampled. Petrographic studies were performed on the thin sections to determine mineral assemblages of peak metamorphic condition. The phase diagrams were calculated using whole-rock analyses reported in Fazlnia (2017) and TheriakDomino software (de Capitani, 2010).

PetrographyThe main textures of nebulitic migmatites are granoblastic and poikilioblastic, although porphyroblastic texture can be observed in places. Stabe mineral assemblage cordierite + spinel + garnet + prtithic K-feldspar + plagioclase together with dissolved silimanites and biotites inclusions represent the peak metamorphic condition. Corundum + spinel sympetectic around the cordierites also form in high metamorphic degrees (Whittington et al, 1998). With increasing metamorphic degree, the biotites and cordierites become less and the more, respectively.Phase diagramsThe P-T phase diagram was calculated in Na2O-CaO-K2O-FeO-MgO-SiO2-H2O (NCKFMASH) chemical system with fluid as pure water and in excess. According to it, mineral assemblage feldspar + chlorite + biotite + muscovite + quartz was stable at temperatures below 550 °C and represents hornblende hornfels zone of the area metapelitic rocks. Partial melting occurs at 700 that increases up to 750 °C with pressure increasing. The assemblage feldspar + garnet + biotite + cordierite + quartz melt + H2O observed in the xenoliths occurs a pressures below 5 kbar. Although, comparing calculated almandin isopleth for garnet and phlogopite for biotite with chemical compositions of these minerals represented in Fazlnia (2017) indicates that anatexis could onset in lower temperatures.According to the calculated T-XCO2 diagram, the partial melting occurs in lower temperatures with increasing in CO2 content of the fluid. Also, T-XO2 diagram show that presence of sufficient O2 in the environment could decrease the partial melting temperatre to below 700 °C. Moreover, the T-Mg# diagram (Mg# = MgO/MgO+FeO) reveals that low Mg# contents of these rocks (0.2 – 0.3) could trigger anatexis in temperatures below 700 °C.

Falling of metapelitic xenoliths in Chah-Bazargan batholith producing magma caused intense contact metamorphism and partial melting. In the peak condition, the assemblage cordierite + spinel + K-feldspar + garnet + palgiocasle together with corundum + spinel intergrowth on cordierite formed. Based on the calculated phase diagrams, anatexis occured in temperatures 700 – 750 °C and pressures less than 5 kbar, however, chemical compositions of the garnets and biotites from the xenoliths show that it could onset in lower temperatures. The T-XCO2, T-XO2, T-Mg# diagrams reveal that increasing CO2 and O2 and high FeO contents of the protolith probably triggered anatexis in lower temperatures.

Hypertension is an important and controllable risk factor for heart diseases, stroke, renal failure and peripheral vascular disease. The aim of this study was to determine the level of awareness of patients with hemorrhagic stroke to control blood pressure and to provide solutions to improve patients’ awareness.

This study is a descriptive cross-sectional study that was conducted to evaluate the knowledge of patients with hemorrhagic stroke about the use of antihypertensives. The study population consists of all patients with hemorrhagic stroke, who were admitted to the intensive care unit of Imam Hossein Hospital in Tehran from September 2020 to March 2021. Data related to blood pressure awareness and drug history was completed by the researcher through the method of direct contact with the patients or their relatives. In this study, 17 patients diagnosed with hemorrhagic stroke due to hypertension who were admitted to the intensive care unit of Imam Hossein Hospital in Tehran, were included. The extent of the exact treatment adherence was assessed using the Morisky questionnaire.

In this study, the median of patients age was 67 and 10 (58.82%) of them were women. The median systolic and diastolic blood pressures were 170 and 95 mmHg on admission. 4(23.53%) subjects were not aware of the disease. Out of 13 people who were aware of their hypertension, 11(64.71%) were under the supervision of a physician. However, 7(63.64%) of the subjects, despite being under the supervision of a physician and acceptable drug adherence, did not have controlled blood pressure and expired.

This study is a warning for patients and health care providers to pay more attention to blood pressure control. Furthermore, educating the community as well as medical staff about the importance of timely diagnosis and accurate treatment of hypertension is highly recommended.

In northwest of the Takestan area (NW Iran), as a part of the western Alborz mountain belt, various plutonic (monzodiorite, quartz monzonite, granite, and alkali granite), volcanic (andesite, basalt, basaltic andesite, rhyolite, and dacite) and pyroclastic rocks (tuff, agglomerate, and ignimbrite) are hosted of Eocene age. Electron probe micro analyzing (EPMA) on clinopyroxene, orthopyroxene, biotite, and amphibole show that they are diopside to augite (Mg# = 0.6-0.8), enstatite (Mg# = 0.63-0.68), annite to phlogopite (Fe# = 0.15 - 0.3) and pargasite (Mg# = 0.6 - 0.8), respectively. The plagioclases havedifferent compositions with normal chemical zoning  from labradorite (in the basalts, An% = 40 - 60) to andesine (in the monzodiorite, An% = 27 - 50) to oligoclase (in the other rocks, An% = 13 - 38). All minerals are primary magmatic except for the alkali granite biotites that have low Ti contents whichindicate that they formed by re-equilibrium with a hydrothermal fluid. Chemical compositions of the clinopyroxene, biotite, and amphibole reveal that they crystallized from calc-alkaline magmas formed by subduction of Neo-Tethys oceanic crust beneath the Iran micro-plate. Geothermometry calculations based on the mineral compositions indicate ca. 880 to 980 °C for the basalts, 800 to 850 °C for the andesite and the dacite, 750 to 820 °C for the monzodiorites and the quartz monzonite, and 520 to 670 °C for the alkali granite. High Al contents of the plagioclases from the quartz monzonite and monzodiorite as well as Fe+3 contents of the biotites from the alkali granite show that they formed from oxidized magmas that were suitable for Cu porphyry systems. Propylitic and argillic alteration zones in the area confirm it.

Some mortality due to stroke occur outside the hospital. Therefore, the pre-hospital emergency medical services (EMS) plays an important and vital role in the management of stroke patients. The present study evaluated the knowledge of prehospital emergency medical services (EMS) personnel in the diagnosis of stroke patients.

This cross-sectional study was conducted in hospitals and pre-hospital EMS affiliated to Ilam University of Medical Sciences, Ilam, Iran in 2022. In order to measure the knowledge and awareness of pre-hospital EMS personnel regarding stroke, a researcher-made questionnaire containing 20 questions, as well as demographic data such as age, gender, field of study was collected.

The mean age of 109 pre-hospital EMS personnel was 32.4±6.6 years old. Most of them were graduates of associate degree in emergency medicine. The mean score of knowledge obtained by the pre-hospital EMS personnel was 16.9±3.5 out of 20, which according to the grading, the knowledge level was estimated to be very good. Of course, very weak and weak level of awareness was recorded in 0.9% (n=1) and 1.8% (n=2) of pre-hospital EMS personnel, respectively. No significant relationship was recorded between the mean level of knowledge and field of study.

The findings of the present study showed that the level of knowledge of Ilam pre-hospital EMS personnel in the field of stroke is favorable, however, the knowledge of a very small percentage of them was at a weak or very weak level. It is recommended conducting more studies in this field.

Occupational stress in the Intensive Care Unit (ICU) has a serious impact on the health and quality of life of nurses. Paying attention to the quality of life of nurses and reducing occupational stress can lead to better provision of medical services in the ICU and hospital. Therefore, the present study was conducted to determine the relationship between occupational stress and quality of life in ICU nurses in selected naval hospitals.

In this descriptive-analytical study, 76 ICU nurses in selected naval hospitals in the south of Iran in 2019 participated. Sampling was done by census and available methods. The research tools included the 26-question quality of life (WHOQOL-BREF) and occupational stress questionnaires, which were completed by nurses, and then data were analyzed.

The mean score of occupational stress and quality of life in ICU nurses in selected naval hospitals were estimated as 42.9±1.7 and 62.3±19.1 respectively, both of which are at a moderate level. Occupational stress has an inverse and significant relationship with quality of life in ICU nurses. Occupational stress and quality of life had no significant relationship with any of the ICU nurses' demographic variables.

The findings of the present study demonstrated that there is a significant and inverse relationship between the quality of life and occupational stress in ICU nurses, so the increase in occupational stress of ICU nurses has a negative effect on their quality of life, and this can affect the quality of providing clinical care in hospital. Therefore, improving the quality of life and reducing occupational stress should be on the agenda of health officials.

In this paper, metamorphic conditions (T, P and fluid composition) in greenschist to amphibolite facies transition zone are investigated using textural evidence, composition of the minerals and phase diagrams. Metabasites from the south of Kordestan Province were metamorphosed from sub-greenschist to upper amphibolite facies. Field observations and petrography studies show that there are some rocks containing mineral assemblage hornblende + plagioclase + epidote + quartz formed in conditions intermediate between greenschist and amphibolite facies. Electron microprobe analysis and scanning electron microscopy images reveal that the amphiboles have chemical zoning with actinolite cores and hornblende rims and these chemical changes are discontinous. The plagioclases are commonly oligoclase but there is some remnant albite. The epidotes are enriched in Fe with low clinozoisite contents. Geothermobarometry calculations using the amphibole compositions represent 423 °C and 2 kbar for the cores and 543 oC and 4 kbar for the rims. The calculated phase diagram based on whole-rock composition of a sample indicates that it was formed in 450 to 550 °C and 2.1 to 6.8 kbar that fall in the field of epidote-amphibolite facies condition. The O2 and CO2 vs. T variation phase diagrams show that O2 had a significant role formation of the mineral assemblage but the fluid contained very low CO2. Chemical discontinuities in the amphiboles and the plagioclases with different compositions demonstrate that the studied rocks formed in disequilibrium conditions.

The Alvand batholith contact aureole hornfelses in south of the Serkan area (NW Hamedan province) contain metamorphic assemblage cordierite + garnet + biotite + plagioclase + K-feldspar. Whole rock compositions of the hornfelses show that they formed by metamorphism of a pelitic protolith (with some CaCO3 impurities) that originated from weathering of felsic to intermediate igneous rocks. Electron microprobe analyses indicate that the cordierites and biotites are of Fe-rich associations, the garnets are rich in almandine and spessartine and the plagioclases are oligoclase. Thermobarometry calculations using the in-equilibrium minerals obtained 550 to 620 oC T and >3 kbar P for these rocks. Also, the calculated pseudosections for average composition of these rocks demonstrate that the cordierite + garnet assemblages occurred due to high Mn and Ca contents of the garnets, high Mg contents of the cordierite and probably during uplifts during intrusion of the igneous bodies. Moreover, investigation of variations in fluids during metamorphism show that stability of the cordierite + garnet assemblages needed some CO2 contribution.

Augmented Renal Clearance (ARC) reflects a measured creatinine clearance (CrCl) of more than 130 ml/min. Also, there are two scoring systems for the prediction of the ARC phenomenon i.e., the ARC score (ARCS) and the Augmented Renal Clearance in Trauma Intensive Care score (ARCTICs). The objectives of the current study were the evaluation the effect of using both scoring systems, on the chance of identifying this phenomenon and evaluating the accuracy of the three commonly used formulas for estimating glomerular filtration rate (eGFR) in ICU patients.

  In this prospective cross-sectional study, the CrCls of all patients admitted to the ICU were evaluated by using ARCS and ARCTICS, and for high-risk subjects based on scoring systems, a 12-hour urine sample was collected to measure CrCl. Besides, daily serum creatinine was recorded to estimate the daily eGFR.

  During the study period, 810 subjects were evaluated and 145 were categorized as high-risk using scoring systems. The ARC phenomenon was confirmed in 79 patients on the recruitment day and 81.01 and 18.98% of them were recruited by ARCS and ARCTICS, respectively. The ROC curves showed AUCs > 0.5 for CockcroftGault (C-G) and CKD-EPI with the cut-off of 100.48 and 107.05 mL/min/ 1.73m2, respectively; to detect the ARC phenomenon.

We recommend using ARCS and ARCTICS simultaneously to assess critically ill patients regarding the possibility of the ARC phenomenon which should be confirmed by using urinary CrCl, as none of the formulas could accurately detect the ARC phenomenon, neither the 12-hour CrCl.

 The COVID-19 infection remains a major pandemic threatening global health. Studies revealed that pregnant women are more prone to develop severe illness, with an increased risk of morbidity and mortality. So the objective of this study is to report the clinical presentation and perinatal outcomes after COVID-19 infection during pregnancy or the puerperium.

 In this case series study, since February 2020, 25 pregnant women with a definitive diagnosis of the COVID-19 infection were registered. Their clinical signs and symptoms, laboratory findings, CT manifestations, pregnancy status, were recorded at the first visit, and they were followed six months after diagnosis.

 The most common symptoms were cough, feeling feverish, and dyspnea. Twenty mothers required hospitalization, 5 out of 20 monitored in COVID-ICU. The chest CT scan demonstrated a grand glass appearance in 77% of cases among admitted patients. The total mortality rate in C-ICU (COVID-19 ICU) admitted patients were 80%.

 In this case series, among 25 pregnant women with confirmed COVID-19, the most vulnerable patients were in the early third trimester and twin pregnancy.

The Alvand complex (Hamedan province) comprises several bodies ranging from acidic to intermediate and basic compositions intruded in the regional metamorphic sequence of the area (the Hamedan phyllites) during various magmatic episodes in Jurassic. In northern part of the complex (the Cheshmeh-Ghasaban area) there are some outcrops of hornblende gabbro and olivine gabbronorite. The olivine-gabbronorites are composed of olivine, clino- and ortho-pyroxene, plagioclase and hornblende. Apatite, magnetite, titano-magnetite, pyrite and chalcopyrite are the accessory minerals. The alterations include substitution of the olivine and pyroxene by bolingite, serpentine and chlorite. Electron microprobe analyses show that the amphiboles are of pargasite, and magnesio-hornblende. Variations of MgO, Al2O3 and Na2O and thermobarometry calculations based on amphibole and plagioclase compositions indicate that pargasites formed in average pressure and temperature of 11 kbar and 835°C, from metasomatized mantle derived melt as a result of asthenospheric mantle elevation and in extensional setting. Mafic magma contaminated with crustal material as it ascends. This situation can be provided in a rift setting (probably a back arc basin). Investigation of Fe and Ti concentration variations in the plagioclases indicates that differentiation trend of the parental magma was not consistent with concentration of these elements in the melt. High fO2 and slow cooling rate of the magma caused Fe-depletion during plagioclase crystallization. In addition, formation from a Fe-depleted source could be another factor that limited iron mineralization of the Cheshmeh-Ghasaban olivine-gabbronorite.

The Garmab area is located in NW of Kamyaran and belongs to the Kermanshah Ophiolite Zone. This complex is located between the Sanandaj-Sirjan and the Zagros thrust zones. Peridotite rocks in the complex were replaced by serpentinite completely or partly due to hydrothermal alteration. Petrographic studies show that the serpentines formed by hydration of both olivine and orthopyroxene minerals. Electron microprobe and X-ray diffraction (XRD) analyses of the samples indicate that the Garmab serpentinites contain all the three serpentine polymorphs (chrysotile, lizardite, antigorite). Those serpentines replacing olivines have higher SiO2 and lower Al2O3, Cr2O3 and TiO2 than those replacing orthopyroxene. This clearly demonstrates their different sources. The calculated phase diagram for the studied samples shows that serpentinites probably formed in two metamorphism events; the first one includes alteration and hydration of harzburgite in T< 200 oC and P < 4 kbar, while the second one occurred due to increasing T and P to more than 400 oC and 4 kbar.

Disease-related malnutrition of neurocritical illness harms its treatment, which increases the mortality rate. The aim of this study was evaluating the effect of a high protein diet on the dietary factors, clinical outcome, and mortality rate of neurocritical patients. In a randomized controlled trial, 15 neurocritical patients were recruited in each group. Patients in the intervention and control groups received high protein and conventional protein regimens, respectively. The Clinical Extended Glasgow Outcome Scale (GOSE) measured at one, two, and three months later. Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, Glasgow Coma Scale (GCS), the serum level of transthyretin (TTR) on the first, 3rd and fifth days of admission, and nitrogen balance (NB) at the baseline and fifth day of the study recorded. Thirty patients, 15 in each group, entered into the study. There was no statistically significant difference in the baseline characteristics of the patients between the two groups of the study. The 28-days-mortality rate in the intervention and control group were 33.3% (n = 5) and 73.3% (n=11), P-value = 0.034, respectively. The GOSE scores were higher in patients who received a high protein diet, and lower in patients with lower baseline TTR, higher APACHE-II score, older age, and a baseline negative nitrogen balance. The high protein diet may decrease the mortality rate, and improve the clinical outcome of neurocritical patients. The baseline TTR level, APACHE II score, and NB are prognostic factors for the prediction of the GOSE in neurocritical patients.

Intensive Care Unit (ICU) is a ward that is critical to improving the health status of critical conditions. Data mining seems to be a good way to optimize the use of resources. Identifying and analyzing the risk factors associated with mortality will lead to more efficient and accurate planning of hospitalization and interventions. In this study, the prediction of mortality of patients in the intensive care unit of Imam Hossein Hospital in Tehran with data mining techniques is discussed.

Based on patient records and hospital information system, 838 patients admitted to the General intensive care unit between 2013 and 2019 in Imam Hossein Hospital in Tehran, the data is needed to collect this research. Algorithms used to classify patients include support vector machines, k nearest neighbor, decision tree, logistic regression and random forest that was reported based on the precision, accuracy, sensitivity, specificity, and roc under the curve.

The results of this study showed, identified 26 factors affecting specific data and pre-processing of data. Among five of the algorithms used in the study, logistic regression algorithm based on the level of roc curve (0.76), accuracy percentage (75.62),precision (68.39),sensitivity (38.65) and specificity (94.53) had better performance in predicting mortality compared to other techniques of study. The variables of Glucose and Partial Thromboplastin time were the most significant effects on mortality based on the logistic regression model.

Data analysis in intensive care unit patients can be an appropriate and practical tool for predicting mortality and its related factors, but according to the quality of data, results are different. And the results extracted from logistic regression can be used as a model to predict the status of mortality in the intensive care unit.

The purpose of this study was evaluating the efficacy and safety of intravenous (IV) ampicillin–sulbactam plus nebulized colistin in the treatment of Ventilator-Associated Pneumonia (VAP) caused by MDR Acinetobacter (MDRA)in ICU patients as an alternative to IV plus nebulized colistin. In this single-blinded RCT, one group received IV colistin and another group IV ampicillin–sulbactam (16 and 12 patients from total 28 patients, respectively) for 14 days or since clinical response. Both groups received nebulized colistin by mesh nebulizer. There were no statistically significant differences between the 2 groups in baseline characteristics and previous antibiotic therapy. In follow up period, no significant difference was observed between 2 groups in rate of microbiological eradication, clinical signs of VAP improvement, survival rate and length of hospital as well as ICU stays. Although we have found no significant differences in Acute Kidney Injury (AKI) incidence between two groups, comparison of cumulative patient-days with stages 2 and 3 AKI with days with no or stage 1 AKI, according to AKIN criteria, revealed significant difference in IV colistin versus IV ampicillin–sulbactam group (p = 0.013). The results demonstrated that the high dose IV ampicillin–sulbactam plus nebulized colistin regimen has comparable efficacy with IV plus nebulized colistin in the treatment of VAP caused by MDRA,withsensitivity to colistin only, with probably lower incidence of kidney injury.

The relationship of vitamin D3 with the duration of mechanical ventilation and mortality is still unknown. Therefore, this study aimed to determine the effect of using high-dose vitamin D on the duration of mechanical ventilation among the patients admitted to the intensive care unit. The current double-blinded clinical trial was performed on 44 mechanically ventilated, adult patients. Using permuted block randomization, the patients were recruited in intervention and placebo arms. In the placebo group, four patients were excluded due to death before 72 h. The vitamin D level was measured in both groups on entrance and 7th day of the study. The intervention and placebo groups received intramuscular injection of 300000 IU vitamin D and identical placebo, respectively. SOFA and CPIS score were evaluated daily for 7 days and on 14th and 28th days of the study. Also duration of mechanical ventilation and mortality rate were recorded. Fourteen males and 8 females were recruited in the intervention group, as well as 13 males and 5 females in the control group. There was no significant difference in baseline characteristics of the patients including gender and age. The mean duration of the mechanical ventilation was 17.63 ± 14 days in the intervention group versus 27.72 ± 22.48 days in the control group (p = 0.06). Mortality rate in control and intervention groups was 61.1% versus 36.3% (p = 0.00), respectively. Administration of high-dose vitamin D could reduce mortality in mechanically ventilated patients. Despite decrease of 10 days in duration of mechanical ventilation, the difference was not statistically significant. Larger studies are recommended.

Due to the emerging antibiotic resistance of Acinetobacter, which is the leading cause of ventilator-associated pneumonia (VAP) in critically ill patients, there is an urgent need for studies comparing various antibiotic regimens for its treatment. In this single blinded randomized clinical trial, adult patients with VAP due to multi drug resistant Acinetobacter (MDRA), were randomly assigned to receive 9×109 unit loading dose of Colistin followed by 4.5×109 unit intravenously twice daily plus 750mg intravenous Levofloxacin daily or continuous infusion of Ampicillin/Sulbactam, 24g daily plus 750mg IV Levofloxacin daily. Dose and dosing interval were adjusted according to serum creatinine levels during the study. Clinical and microbiological cure, inflammatory biomarkers and possible adverse effects were recorded in participants. Twenty-nine patients were recruited (14 in Colistin and 15 in Ampicillin/Sulbactam groups). Three patient excluded in each group. Clinical response occurred in 3 (27%) and 10 (83%) in Colistin and Ampicillin-Sulbactam arms, respectively (P=0.007). Nephrotoxicity happened in 6 (54%) and 1 (8%) of cases in Colistin and Ampicillin-Sulbactam groups, (P=0.016). 14-day and 28-day survival rate were significantly higher in Ampicillin-Sulbactam group compared to Colistin arm with P values of 0.002 and 0.049, respectively. This study revealed that Levofloxacin plus high dose Ampicillin/Sulbactam as continuous infusion is more effective than Levofloxacin plus Colistin in patients with MDR Acinetobacter VAP with significantly lower risk of nephrotoxicity.