pardis moradnejad

Infective endocarditis (IE) is associated with several morbidities and high rate of mortality. Predicting these morbidities can be helpful in managing patients and can prevent possible complications, result from IE. In this study, we aimed to evaluate the association between C-reactive protein (CRP), N-terminal pro brain natriuretic peptide (BNP), monocyte to high density lipoprotein (HDL) ratio Charlson comorbidity index, and European System for Cardiac Operative Risk Evaluation (Euro SCORE) in complicated cases of IE.

This prospective study was conducted on a referral center from January 2017 to December 2020. Patients with definite or possible diagnosis of IE based on the modified Duke criteria were included in this study. Demographic information and serum levels of N-terminal pro BNP, D-Dimer, CRP were evaluated in patients. In addition, we used Charlson comorbidity index and The Euro SCORE for subjective assessment.

One hundred and four patients(64 males, median age: 58) included in the final analysis. Intracardiac involvement, central nervous system (CNS) complications and systemic complications were observed in nine patients(9.7%), 16 patients(15.4%), and eight patients (7.7%) respectively. The mortality rate was 14.4%. D-dimer (P = 0.008), pro-BNP (P = 0.008), and Charlson criteria (P = 0.012) were higher in patients with systematic complications. In addition, NT pro‑BNP was significantly associated with CNS complications (P = 0.04) and D‑Dimer level was significantly associated with in‑hospital mortality (P = 0.008).

Serum biomarkers such as pro‑BNP and D‑dimer, and comorbidity indices can be used for risk stratification of patients with IE. The level of pro‑BNP is significantly associated with CNS complications and the level of D‑dimer is significantly with mortality in patients with IE.

Several microorganisms are associated with infective endocarditis (IE), but the most common IE causes are staphylococci and streptococci. Among streptococci, the viridans group streptococci are responsible for a considerable percentage of all IE cases.

Since 2006, the Iranian Registry of Infective Endocarditis has recorded information regarding all adult patients with a definite or possible IE diagnosis according to the modified Duke criteria. Patients with viridans streptococcal endocarditis were detected through three blood culture sets. The patients’ demographic characteristics, predisposing factors, clinical presentations, and echocardiographic findings were recorded.

Of 731 patients diagnosed with endocarditis, viridans streptococci were found in 46 (6.3%) patients, consisting of 28 (60.9%) men and 18 (39.1%) women at a mean age of 42.56 ± 15.46 years, who were subsequently included in the study. Among the 46 patients with viridans streptococcal endocarditis, 26 had a subacute course, whereas 20 had an acute course. Vegetation was detected in 35 patients. All the patients were treated with the standard antibiotic regimen for viridans streptococcal endocarditis, and cardiac surgery was performed on 16 patients.

Clinicians should pay sufficient heed to the following points in all cases of viridans streptococcal endocarditis: firstly, an appropriate antibiotic regimen must be based on a precise minimal inhibitory concentration determination for the usual antibiotics. Secondly, since prolonged antibiotic therapy is crucial to the eradication of microorganisms within vegetation, all patients with viridans streptococcal endocarditis must receive an adequate therapy course.

Infective Endocarditis (IE) is a life-threatening disease. Regardless of improved healthcare, the incidence of IE has increased over time. A variety of microorganisms have been found to be associated with IE.

This study aimed to determine the incidence of various microorganisms in patients admitted with IE and to assess their relationships with in-hospital complications.

This prospective cross-sectional study was conducted on patients with definite or possible IE based on the Duke criteria at a tertiary referral center between 2016 and 2021. Blood cultures were performed for all the patients to document the positive or negative blood cultures as well as the types of microorganism. Statistical analyses were performed using the SPSS 18 software.

The study population consisted of 286 patients (181 males (63.3%) and 105 females (36.7%)) with the mean age of 49.67 ± 17.11 years. The most common cardiac predisposing factor was the prosthetic valve (n = 110, 38.5%) followed by a history of congenital heart disease (n = 68, 23.8%), while the most frequent non-cardiac predisposing factors were a history of chronic kidney disease (n = 75, 26.2%) and diabetes mellitus (n = 53, 18.5%). The most frequent causative microorganisms were coagulase-negative Staphylococcus (n = 37, 12.9%), Staphylococcus aureus (n = 31, 10.4%), Enterococcus (n = 29, 10.1%), and Streptococcus viridans (n = 14, 4.9%). The most common complications were acute renal failure (26.6%), heart failure (17.5%), and pulmonary involvement (8.4%).

The frequencies of microorganisms related to IE, especially culturenegative IE, vary in different countries, precluding the practical use of a specific guideline around the world. Further research is, therefore, required to determine the epidemiology and microbiology of IE in different countries with a view to eventually devising an individualized guideline appropriate to the epidemiology and microbiology of IE in every country.

Enterococci are responsible for 5% to 18% of infective endocarditis (IE) cases. We aimed to determine demographic data, predisposing factors, clinical presentations, complications and echocardiographic findings concerning enterococcal endocarditis.

Since 2006, all adult patients with a possible or definite diagnosis of IE based on the modified Duke criteria have been enrolled in the Iranian Registry of Infective Endocarditis. In this study, patients with IE of enterococcal origin were detected and their demographic characteristics, predisposing factors, complications, laboratory data and echocardiographic findings were assessed.

Out of 731 patients diagnosed with endocarditis. Enterococci were found in 60 patients: 32 men (53.3%) and 28 women (46.7%) at a mean age of 55.21 ± 17.9 years. Definite IE was diagnosed in 57 (95%) patients, and possible IE was suspected in 3 patients (5%). The most frequent predisposing factor was the prosthetic valve (n=28, 46.7%), followed by a history of previous endocarditis (n=12, 20%). An acute course (<6 wk) was reported in 38 patients (63.3%). Fever (n=58, 95%) and loss of appetite (n=17, 28.3%) were the most frequent symptoms. The most frequent location of involvement was the aortic valve (n=22, 36.7%), followed by the mitral valve (n=20,33.3%). Vegetation was detected in 53 patients (88.3%), abscess formation in 8 (13%). Fifteen patients (25%) had heart failure, and 11 (18%) had central nervoussystem complications. The mortality rate was 20%.

Given the serious complications and the high mortality rate in the patients with IE of enterococcal origin, which may be due to these organisms’ intrinsic resistance to many antibiotics, we suggest further studies to determine more effective antibiotic regimens and even individualized antibiotic therapies for enterococcal endocarditis.

We sought to review studies regarding interventions to prevent or reduce catheter-related bloodstream infections (CRBSIs).

 CRBSIs are associated with peripheral and central intravenous catheters, including nontunneled central catheters, tunneled central catheters, peripherally inserted central venous catheters (PICC), totally implanted intravascular access devices (ports), pulmonary artery catheters, and arterial lines. CRBSIs constitute one of the most frequent complications of intravenous catheters. Infections can be reduced by applying recommendations concerning CRBSIs prevention.

Articles published between 2010 and 2022 were searched out in databases PubMed, Cochrane, Medline, SID, Scopus, IRANDOC, and Magiran using the keywords “prevention”, “bacteremia”, and “catheter-related bloodstream infection” and their Persian equivalents. Original articles and systematic reviews in Persian and English on CRBSI prevention that were published in reliable scientific databases from 2010 to 2022 and had available full texts were selected. The primary research yielded 324 articles via title and abstract reviews and in some cases, full-text perusal. Ultimately, 10 articles fulfilling the research purpose of the present study were reviewed.

According to the articles reviewed herein, medical centers should lessen CRBSIs incidence by educating healthcare personnel regarding intravascular catheter-use indications, proper intravascular catheter insertion procedures, and appropriate infection-control measures. Additionally, they should periodically assess healthcare personnel’s knowledge of and adherence to guidelines vis-à-vis intravascular catheter insertion and maintenance.

It is advisable that healthcare personnel’s knowledge of and adherence to the latest guidelines concerning CRBSIs prevention be continually monitored and enhanced.

The aim of this article is to review studies that have evaluated effective interventions in the prevention of mediastinitis following cardiothoracic surgery.

Mediastinitis and deep surgical wound infections (DSWI) are life-threatening complications of median sternotomy and have a prevalence of 0.4-5 percent. They can produce a significant financial burden on the patient and also the health care system by prolonging the hospitalization period and the need for repeated surgeries or long-term antibiotics. Several risk factors have been identified for mediastinitis following cardiothoracic surgery, many of which are easily preventable by proper diagnosis.

. In this literature review, databases including PubMed, Medline, UpToDate, Scopus, Science Direct, SID, and Magiran were searched out using the keywords Mediastinitis, Prevention, Cardiothoracic surgery, and their Persian equivalents. Persian and English original articles (including cross-sectional, case- control, cohort studies, and clinical trials) investigating the effective interventions in the prevention of me- diastinitis following cardiothoracic surgeries and were published between 2000 and 2021 and had an available full text, were included in the current study; review articles, letter to editors, and case reports published in non-authoritative journals were excluded from this study. After primary search, 62 relevant articles were found and based on inclusion/exclusion criteria, 16 articles were finally selected and reviewed in the cur- rent study.

Mediastinitis ca n be prevented before surgery by hand hygiene, weight loss, smoking cessa-tion, proper prophylactic antibiotics, decolonization of nasopharynx and oropharynx from Staph aureus by Mupirocin ointment, and removing hair using depilatory cream (not the blade). Tight blood glucose monitoring before, after, and during the surgery, disinfection of the surgical field by chlorhexidine, using a proper surgical technique for wound closure and stabilizing the sternum, and proper patient training by nurses about red flags of infection can play an important role in the prevention of mediastinitis.

  Mediastinitis ca n be easily prevented by identifying its risk factors and controlling them accurately and in a timely manner.

The aim of the present study was to examine the effect of early mobilization protocol on the strength of diaphragmatic muscle and other inspiratory muscles after open heart surgery.

Early mobilization is recommended as a safe protocol after open heart surgery to decrease hospital stay and post-op respiratory complications; however, our knowledge about its effect on improving respiratory muscles strength is limited.

  This is a randomized single-blinded clinical trial conducted on 80 consecutive patients who underwent coronary artery bypass surgery and/or valvular surgery that were randomly assigned to experimental group (postoperative early mobilization) and control group (routine physiotherapy). On the day before surgery and the day before leaving intensive care unit (ICU), two scores were measured for assessing diaphragmatic muscle strength: maximum inspiratory pressure (PI max) and Strength index (S index). Hemodynamic parameters were also measured and compared.

According to both PI max and S index, diaphragmatic muscle strength decreased from 77.28 to 59.53 cmH2O in patients after surgery, but the changes in the experimental group was less than the control group, which indicates a significant improvement in the strength of the diaphragm muscle in the experimental group (p≤0.0001). Hemodynamic changes after surgery (lower blood pressure and increased heart rate) occurred in both groups without any significant clinical effect.

  Early mobilization after cardiac surgery has positive effect on the strength of diaphragmatic muscle and is also safe as shown to have no adverse effect on hemodynamic parameters.

This study was conducted to compare the prevalence of neck pain and disability among nurses in intensive care and general wards.

Nursing is known as one of the ten occupations that are associated with musculoskeletal complications. In has been reported that neck and shoulder disorder are more common among nurses with high physical workload than those with low physical workload. So far, few studies have been performed on neck problems in nurses working at intensive care unit.

In this cross-sectional descriptive-comparative study, 40 nurses from intensive care units and 40 nurses from general wards of Rasool Akram hospital, Tehran, Iran, were selected by convenience sampling method. Data collection in both groups was done through completing a checklist of demographic characteristics, Neck Disability Index (NDI) and Neck Pain and Disability Scale (NDPS) questionnaires by participants. The data was analyzed in SPSS version 22 using descriptive and inferential statistics.

The prevalence of neck pain and disability (measured by NDI and NPDS) in all nurses was 77.5 percent and 60 percent, respectively; 90 percent and 70 percent in nurses working at the intensive care units, and 65 percent and 50 percent in nurses working at general wards. The difference in scores measured by NDI was statistically significant between nurses working at the intensive care units and those working at general wards (P=0.014).

The prevalence of neck pain was significantly high in nurses, which could be due to their high workload that requires appropriate preventive measures and reduction of their physical workload.

Acute kidney injury (AKI) due to antibiotic nephrotoxicity is a complication that can be avoided or managed properly if diagnosed early.

We aimed to determine the incidence and risk factors of AKI and to assess the possible effects of nephrotoxic antibiotic therapy on its development in a large group of patients with infective endocarditis (IE).

Patients with definite or possible IE diagnosed based on the Duke criteria were included in this retrospective cohort study at a tertiary referral center from 2007 to 2017. Data were derived from the single-center Iranian Registry of Infective Endocarditis (IRIE). Baseline risk factors for AKI were assessed via repeated serum creatinine measurements. Patients (n = 22) with end-stage renal failure undergoing dialysis were excluded. AKI was defined and staged in accordance with the Kidney Disease: Improving Global Outcomes (KDIGO) classification.

Totally, 498 patients at a mean age of 45 ± 16 years were studied. The baseline creatinine level was 1.26 ± 0.72 mg/dL. AKI occurred in 126 (26.3%) patients 1 week after the initiation of antibiotic therapy. There was a significant relationship between AKI and the use of gentamicin (P = 0.01) and gentamicin and vancomycin concomitantly (P = 0.01). At the end of the treatment, after dose adjustment and additional treatments, the incidence of AKI decreased to 22.7%, whereas this improvement was less remarkable in the patients with prior renal failure. Some independent variables, including age (P = 0.04), diabetes (P < 0.0001), prior renal failure (creatinine > 2 mg/dL), anemia (P = 0.003), left-sided IE (P = 0.04), and positive blood cultures with Staphylococcus aureus (P = 0.04) had a statistically significant association with AKI.

Close monitoring of the renal function is essential in IE patients receiving treatment with nephrotoxic antibiotics, especially patients with advanced age, diabetes, chronic renal failure, anemia, and left-sided IE.

Considering reductions in AIDS-related mortalities following effective anti-retroviral treatments in HIV/AIDS patients, HCV-associated liver diseases have turned into a major concern for HIV/HCV co-infected patients. The present study aims at determining SVR rates in HIV/HCV co-infected patients under pegylated interferon and ribavirin treatment referring to Tehran Imam Khomeini hospital during 2010 - 2013.
In this descriptive cross-sectional study, all HIV/HCV co-infected patients under pegilated interferon and ribavirin treatment referring to Tehran Imam Khomeini Hospital during 2010 - 2013 entered the study. The variables include demographic information, genotype, liver involvement stage in biopsy, viral load levels prior to treatment, 4th, 12th, and 48th week as well as 6 months after treatment (sustained virologic response (SVR)), and CD4 count every 3 months.
In the total of 28 male HIV/HCV co-infected patients of this study, 21.4% and 78.6% received peg IFN alfa- 2b, and pegIFN alfa- 2a, respectively. There were 17 genotype I (61%), 9 (32%) genotype III, and 2 (7%) genotype II among the patients. The overall SVR rate of the patients was 67.8%; it was 52.9% in genotype I and 72.7% in genotypes II and III. Despite the CD4 count decline during treatment, opportunistic infections were not observed in any of the patients
SVR rates in this study are higher than studies conducted in other countries and this implies the possibility of a more favorable genetic trait in Iranian HCV patients responding to pegIFN and ribavirin. That is still the proper regimen due to high price of free interferon regimens in Iran.

Aspergillus is a fungus found in the environment. In an immunecompetent person, inhalation of spores may cause localized infection. In immune compromised patients, these fungi can cause life-threatening invasive infections. Invasive aspergillosis has a poor prognosis.
We describe a case of cerebral aspergillosis in an immunecompetent patient. A 29-year-old woman was admitted with seizures and headaches. Magnetic resonance imaging (MRI) of the brain showed two masses one mass in the left frontal lobe and one in parietal lobe. Excisional biopsies showed granulomatous reactions, mixed inflammatory infiltration, fibrosis, and necropurulent material mixed with fungal hyphae featuring acute-angle branching and septation, which was compatible with aspergillosis. Amphotericin B deoxycholate (1 mg/kg IV daily) was begun. The results of testing for human immunodeficiency virus (HIV) and nitroblue tetrazolium (NBT) for chronic granulomatous disease (CGD) were negative. The patient had two subsequent recurrences, and surgery and medical treatments were prescribed. Presently, after two years of follow-up, she has no symptoms and her MRI is normal.
Most cases of invasive aspergillosis show that this organism is pathogenic in immunocompromised patients; however, some case reports show that invasive aspergillosis may not be so rare in immunocompetent patients. In these patients, virulent and drug-resistant forms of aspergillus may be responsible for the disease, and treatment with antifungal agents is often ineffective, so that surgical excision is required.

To describe a case of bilateral presumed tuberculous choroiditis which resolved promptly with a short course of antituberculous therapy.
Case Report: A 44‑year‑old lady presented with bilateral visual loss of 8 months’duration. Considering the presence of pan‑uveitis, severe macular edema, multifocal leakage on fluorescein angiography, positive tuberculin skin test, and after excluding other diseases, she underwent anti‑tuberculous therapy (ATT) for disseminated choroiditis due to presumed ocular tuberculosis. She improved promptly and completely. There were no signs of relapse 18 months after completion of the treatment course. In a young patient with disseminated choroiditis and relatively short duration of symptoms, a course of ATT for 6 months may effectively treat the disease preventing relapse for a considerable period of time.
In Presumed Tuberculous chroiditis early diagnosis is crucial for prompt and complete improvement.

Abacavir is an anti-retroviral medication used to treat HIV infected/AIDS patients and its efficacy has been proven in randomized clinical trials. The most significant adverse reaction associated with abacavir is the acute hypersensitivity phenomenon which manifests in many forms and in severe cases could result in death. Hypersensitivity reaction to abacavir has been closely linked to the presence of HLA-B*57:01 allele. Avoidance of abacavir initiation in allele-positive patients is the most effective strategy in preventing possible severe hypersensitivity reactions. Previous epidemiologic studies have made great strides toward delineating HLA-B*57:01 allele frequency in different regions of the World and the available results indicate significant discrepancy between geographical regions. Despite these efforts, no study to date has determined the allele frequency among Iranian HIV-positive patients. The aim of the present study was to determine the proportion of allele-positive patients among a group of Iranian HIV-infected patients. Between September 2012 and February 2013, 122 HIV-positive patients were selected among patients referred to Imam Khomeini Hospital’s Consultation cen-ter for high risk behaviors using the convenience sampling method. Sampling scheme was designed in a manner to include equal number of infected patients with and without clinical Acquired Immunodeficiency Syndrome (AIDS). Patient data was collected using available records and a blood sample for DNA analysis was also obtained. Presence of HLA-B*57:01 allele was determined using the Polymerase Chain Reaction- Sequence Specific Method (PCR-SSP). Seventy three patients (59.8%) were male. Co-infection with hepatitis B and C was observed in 1.7% and 40.7% of the patients, respectively. History of addiction and anti-retroviral therapy was positive in 50.0% and 60.7% of the patients, respectively. Overall, three patients were allele-positive which corresponds to a frequency of 2.46% (95% CI: 0.005-7.30). No association between presence of allele and investigated vari-ables were identified. Frequency of HLA-B*57:01 allele among a group of Iranian HIV-infected patients is estimated to be 2.5%. This rate is comparable to those reported in other Middle-Eastern countries, yet is relatively lower than reports generated from South-Eastern Asia, Europe, and the United States. Future studies with larger sample sizes are needed to corroborate these findings.

Intestinal tuberculosis is an uncommon presentation of tuberculosis (TB) and has clinicopathological similarities with Crohn’s disease. In regions where TB is endemic clinicians must aware of this condition and fully evaluate their patients when Crohn‘s disease is diagnosed. We recommend all pathologic specimens be evaluate effectively for TB.Smear,culture and PCR for Mycobacterium.tuberculosis from samples aside the pathological reviews help for better diagnosis. Here we present a case of intestinal tuberculosis which initially diagnosed as Crohn’s disease but after starting immunosuppressive agents he presented with disseminated tuberculosis.

Disseminated tuberculosis (TB) is commonly seen in HIV-infected patients and is major cause of death in these patients. In HIV-infected patients disseminated tuberculosis is frequently undiagnosed or misdiagnosed. In this article we report a case of disseminated TB in a HIV-infected patient with a relatively long history of fever and other complaints without definite diagnosis. Diagnosis of disseminated TB was confirmed by bone marrow biopsy and polymerase chain reaction analysis (PCR) of the ascitic fluid. With anti-TB treatment signs and symptoms improved