mohammadmahdi sabahi

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

Health care associated infections (HAIs) are a class of infections that infect patients during hospital admissions and receive medical services. These infections occurs within 48 to 72 hours of admission and up to 6 weeks after discharge. Surveillance of device-associated infections (DAIs) in intensive care units (ICUs) is substantial in planning healthcare strategies. This study was conducted to determine the device-associated infections' burden and antimicrobial resistance patterns.

In this descriptive-analytic study, three common device-associated infections included central line-associated bloodstream infection (CLA-BSI), ventilator associated pneumonia (VAP), and catheter-associated urinary tract infection (CA-UTI), were assessed in intensive care units of Besat Hospital in Hamedan from April 2017 to April 2018. In order to determine the incidence of device-associated infections, the number of device-associated infection cases was calculated during the study period and divided into the number of device-days used. The device-days included all days of exposure to that device (vascular catheter, endotracheal tube (ventilator), or urinary catheter) in all patients in the study population.

Out of 1806 intensive care unit admitted cases, 168 patients (9.3%) were device-associated infection with distribution of 92 cases (55%) of ventilator-associated pneumonia (VAP), 56 cases (34%) of catheter-associated urinary tract infection (CA-UTI) and 20 cases (11%) of central line-associated bloodstream infection (CL-BSI). The incidence of VAP, CA-UTI and CL-BSI was 44.7, 17.5, and 21.61 days, respectively. The most organisms were Acinetobacter (27.4%), Klebsiella (18.3%), Escherichia coli (E. coli) (15.4%). Vancomycin-resistant enterococcus (VRE) was 75%. Acinetobacter resistance to colistin and carbapenem was 16.8%. About half of Pseudomonas isolates were resistant to meropenem.

According to the present findings of this study, a high incidence of device-associated infections and resistant organisms in our intensive care units were documented, which represents a need to reinforce the preventive and control programs. Various results in different studies can be due to differences in the level of health care in different centers and countries.

The patient is a 50-year-old man who has been diagnosed with abdominal pain, fever, shivering and constipation with nausea and vomiting with a possible diagnosis of typhoid. Computed tomography (CT) of the abdomen and pelvis was performed by injection of contrast agent for the patient. What is your diagnosis?

Nosocomial infection is one of the most daunting challenges to the global health care system. The current study aimed to compare the antimicrobial resistance pattern in hospital versus community-acquired infections in pediatric patients in Besat Hospital, Hamadan, Iran.

The current study was carried out on all patients with a hospital-acquired infection (HAI) who were hospitalized in Besat Hospital, Hamadan, Iran, for 48 hours. Moreover, patients with community-acquired infections (who had an infection before hospitalization) were also included in the current study. E-test and Kirby-Bauer disk diffusion test were utilized to determine antimicrobial susceptibility patterns according to the report test/CLSI M100/S27 guidelines. Antibiotic resistance patterns in both patients with hospital and community-acquired infections were separately recorded. Subsequently, the obtained data were analyzed by SPSS 16.

A number of 43 and 68 patients showed HAI and CAI, respectively. The most common HAI and CAI were blood-stream infection and urinary tract infection (UTI) with a prevalence of 69.8%, and 73.5%, respectively. The most frequent organisms isolated from CA and HA-infections were E. coli and Staphylococcus aureus with a prevalence of 67.9%, and 30.2%, respectively. The highest level of resistance in Gram-negative bacteria was observed against cotrimoxazole and ceftriaxone. Furthermore, the highest resistance in Gram-positive organisms was against clindamycin. The prevalence rates of MRSA isolates in HAI and CAI were reported as 46.2% and 36.9%, respectively.

The obtained results indicated the high resistance to several antibiotics that can be used as promising choices in the treatment of both CA and HA-infections. It is recommended that region-specific monitoring studies be carried out in order to assist the clinician to select the accurate empirical therapy.

Epidemiology and predisposing factors of spondylodiscitis or vertebral osteomyelitis are different in different populations. This study was conducted to delineate the epidemiology and microbiological status of in Hamedan, Iran.
In this retrospective study, all patients with definite diagnosis of spondylodiscitis (changing of intervertebral disc and adjacent vertebral MRI signal) hospitalized in Besat and Farshchian Hospitals of Hamedan between 2006 and 2015 (during 10 years) were enrolled by convenience sampling. Data on age, gender, underlying disease, constitutional symptoms, place of acquiring infection, leukocytosis, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), surgical intervention, vertebral biopsy culture, anemia, abscess, place of vertebral involvement, positive brucellosis test, and blood culture results were obtained from the patients’ medical files and recorded in a questionnaire.
A total of 71 patients with spondylodiscitis (mean age: 49.56 years) were enrolled. Brucella (n: 27, 38%) was the leading cause of the disease followed by tuberculosis (n: 11, 15.5%). Although 34 patients had positive serologic test for Brucella, other agents were causes of the disease according to course of treatment and vertebral biopsy in 7 of them. In 21 cases, the cause of the disease was unknown. The most common place of involvement was lumbosacral region (78.9%).
Unlike Infectious Diseases Society of America (IDSA) guideline that do not recommend to perform age-guided aspiration biopsy in suspected cases of spondylodiscitis when Brucella is endemic and whereby people have strong positive serology, our results demonstrated that, even in case of positive Brucella test, other factors are likely to contribute to acquiring spondylodiscitis, and vertebral biopsy is recommended for definite diagnosis. Early diagnosis is necessary to select appropriate antibiotic and treat spondylodiscitis early.

Aims:

 Various evidences have shown the effect of ovarian hormones on locomotor activities and catalepsy induced by a variety of stimuli. The aim of this study was to evaluate the effects of estrogen and progesterone on catalepsy and motor and balance impairment classified as haloperidol-induced extrapyramidal disorders.

Materials and Methods:

 The current experimental study was performed on 96 female Wistar rats (180-200g). These rats were randomly divided into 16 groups (n=6). Prior to administration of haloperidol, the rats were pretreated with flutamide (10mg/kg, i.p.), estrogen (1mg/kg 17 β-estradiol, s.c.), and/or progesterone (1mg/kg, i.p.) for 1 day or 7 consecutive days. The effects of estrogen and progesterone on haloperidol-induced catalepsy and motor impairment were assessed by a bar test and a rotarod performance test, respectively. Data were analyzed by SPSS 22 software using ANCOVA and Tukey test.

Findings:

 One to 7-day treatment with estrogen had a protective effect on haloperidol-induced extrapyramidal disorders such that it significantly improved catalepsy and motor impairment in the rats and restored and normalized their motor levels. However, the progesterone administration did not represent significant effects in improving extrapyramidal symptoms and a slight improvement was achieved. The co-administration of flutamide significantly reduced the protective effect of estrogen on catalepsy and motor balance impairment induced by haloperidol.

Conclusion:

 The deficiency of ovarian hormones increases catalepsy; however, this disorder is more likely to occur due to estrogen insufficiency. Hence, progesterone plays a little role in it. Moreover, the anti-cataleptic effect of ovarian hormones is exerted through affecting androgenic receptors.