payam tabarsi

This study aims to investigate the clinical and demographic features of underlying medical conditions and the potential relationship between underlying diseases and the increased rate of morbidity and mortality due to COVID-19.
This study was conducted on 350 COVID-19 patients hospitalized at the Masih Daneshvari Hospital from February-July 2021. All participants had confirmed COVID-19 diagnosis based on symptoms and/or positive PCR test or chest X-ray results. Data was collected from medical records on demographics, disease severity, symptoms, underlying conditions like diabetes, hypertension, coronary heart disease, obesity, renal disease/transplantation, and outcomes like hospital stay, ICU admission, and mortality. Relationships between age, underlying diseases, and mortality were analyzed using chi-square and Fisher's exact tests."
A total of 350 patients diagnosed with COVID-19 were included in the study, with an average estimated age of (60.8±15.4). The age group of 56 and above had the highest morbidity rate, which accounted for 50% of the total participants. Among the COVID-19 patients, diabetes was the most common underlying medical condition, accounting for 31.4% of the cases. High blood pressure was present in 27.1% of the patients, and 17.1% of the total participants had coronary heart disease (CHD). Additionally, 10.9% of the participants were overweight, and 30 of them had previously experienced kidney failure or transplantation. Moreover, the study found that 40% of patients with diabetes died, while the mortality rate was 38.3% in patients with CHD and 47.4% in overweight participants. High blood pressure patients had a mortality rate of 43.2%, and patients with renal failure or kidney transplantation had a significantly increased risk of mortality at 83.3%. The research also revealed a significant and direct relationship between mortality rate, age group, and underlying disease among the patients (P<0.05).
The findings of the present study hold significant implications for preventive interventions and policy adoption, particularly in relation to the use of calendar age as the key criterion for risk evaluation. These results underscore the need for a more precise and focused approach to prioritizing patients with identified risk factors.

Most mortality in COVID-19 cases was due to the increased inflammatory cytokines and cytokine storm. As mesenchymal stem cells (MSCs) possess immunomodulatory properties, this study assessed the therapeutic effects of placental MSC-derived extracellular vesicles on the inflammation and pulmonary injury caused by COVID-19. 

The study was carried out in phases I (safety study, 101 patients) and II (efficacy study, 80 patients) in a randomized, double-blind study at four hospital centers from April 2021 to August 2021. In addition to standard treatments, 15 mL of normal saline solution containing 15×109 vesicles was injected intravenously for five consecutive days.

No reaction or adverse events were observed in any patients. In the intervention group, after 5 days of treatment, patients’ clinical status and oxygenation improved, and 75% of patients presented an increased SpO2 after 5 days. Besides, inflammatory parameters assessment indicated a 21% decrease in neutrophil-lymphocyte ratio and a 54% reduction in C-reactive protein after day five of the intervention. 

PMSC-derived extracellular vesicles were safe and well-tolerated, down-regulated cytokine storms, and restored oxygenation. Thus, they can be considered a promising therapeutic candidate for severe COVID-19.

Patients with immunodeficiency are at higher risk of severe disease and death following SARS-CoV-2 infection compared to the general population. Here, we describe humoral and cellular immune responses in 5 patients with immunodeficiency, 2 patients with multiple sclerosis, 1 patient with chronic lymphocytic leukemia (CLL), 1 patient with Good’s syndrome, and 1Human Immunodeficiency Virus (HIV) positive with developed Acquired immunodeficiency syndrome (AIDS)- patient. T-cell responses were evaluated using the QuantiFERON SARS-CoV-2 assay following incubation with the SARS-CoV-2 Ag1, Ag2, and Ag3 viral antigens. Immunophenotyping of CD4+ and CD8+ T cells and CD19+ and CD20+ B cells was determined by flow cytometry. All studied immunocompromised patients or those with acquired immune dysregulation patients showed reduced cellular immune responses (release of interferon (IFN)-g) to SARS-CoV-2 antigens than healthy controls [patients; Ag1, Ag2 and Ag3 and Nil (Median 5-95% percentile) (12 (1-95), 12 (1.5-78), 13.5 (12-95) and 3 (1-98) U/mL)], controls; Ag1, Ag2 and Ag3 and Nil (Median 5-95% percentile) 24.5 (7-89), 65 (31-173), 53.5 (13-71.5) and 3 (1-14) U/mL)]. The frequency of peripheral blood B cells was also reduced in these patients compared to healthy control subjects. T-cell-dependent antibody responses require the activation of B cells by helper T cells. Reduced B cell numbers in immunocompromised patients infected with SARS-CoV-2 indicate the need for these patients to take additional precautions to prevent COVID-19 infection.

Providencia species are opportunistic pathogens that can rarely cause nosocomial infections. They possess numerous virulence characteristics, such as intrinsic antibiotic resistance, which enable them to cause lethal outbreaks. The emergence of pan-drug resistant (PDR) isolates amplifies the threat of Providencia spp. to human health.

We described an outbreak caused by PDR Providencia spp. in the intensive care unit (ICU) of our medical center.

This outbreak occurred at Imam Hossein Hospital in Tehran, Iran, between 20 June and 28 July 2023. The majority of the 14 patients experienced ventilator-associated pneumonia (VAP); however, two others had surgical site infections (SSI) and peritoneal abscesses. Samples were subcultured on Blood agar, Chocolate agar, and MacConkey agar, as well as differential gallery mediums. Additionally, susceptibility to antimicrobial agents was determined by the disk diffusion protocol using Mueller-Hinton (MH) agar.

The rapid diagnosis of the outbreak and practical measures recommended by the infection prevention and control (IPC) committee (e.g., sampling from other patients, hands of healthcare workers, and the environment to identify further cases and the source of the infection, contact isolation, disinfection of the ICU with 1% chlorine solution, and combined antibiotic therapy) assisted us in managing it. Nevertheless, the outbreak resulted in the mortality of eight patients, despite these preventive and therapeutic measures.

Clinicians should be aware of nosocomial infections caused by opportunistic pathogens such as Providencia spp., especially in ICU-admitted patients with prolonged hospitalizations and broad-spectrum antibiotic administration. Strong clinical suspicion and timely detection of outbreaks, investigation of further cases, contact isolation of infected patients, disinfection of the environment, treatment with combined antibiotic regimens, and re-sampling of patients and the environment are the cornerstones of managing outbreaks caused by Providencia spp.

There are variables whose influence on the risk of tuberculosis (TB) recurrence change over time. Therefore, this study aimed to assess the time-dependent effects of these variables on the hazard of TB recurrence.

In this historical cohort study, data were collected from 4,564 TB patients who were referred to the TB research center of Dr. Masih Daneshvari Hospital, Tehran, from 2005 to 2015, in order to evaluate factors affecting the hazard of TB recurrence in terms of time dependency or time constancy. Data were analyzed in STATA 14 software using a statistical test based on Schoenfeld residuals, the time-dependent effects method, and the time-varying effects model (considering time function as f (t) = t).

The results showed that only the impact of the variables of drug adverse effects and passive smoker were inconstant over time and had time-dependent effects, and they also influenced the hazard of TB recurrence. Also, the effect of the two mentioned variables on the hazard of TB recurrence displayed a decreasing and increasing trend with time, respectively.

Using the time-varying effects model in the study of the hazard of TB recurrence allows evaluating the time-dependent effects of the studied variables and also can differentiate them from the time-independent variables.

We aimed to evaluate the accuracy of genotyping of Leishmania species by the spliced leader mini-exon gene.

Suspected leishmaniasis patients, referred to Masieh Daneshvary Hospital, Tehran, Iran were included from May 2017 to September 2021. The Leishmania species were genotyped by PCR-RFLP based on the SL mini-exon gene and the ITS1 region of SSU-rRNA gene and compared with the sequencing results. The expressed metabolites of metacyclic promastigotes were evaluated by Proton nuclear magnetic resonance (1H-NMR).

Out of 66 suspected cases, 36 (54.4%) were positive for Leishmania species based on the PCR assays. In 21 (31.8%) cases, promastigotes grew on culture tubes. Based on the RFLP of SL RNA profile, 13 (19.7%) L. tropica, 9 (13.6%) L. major, 3 (4.5%) L. infantum, and 8 (12.1%) C. fasciculata isolates, isolated from culture media, were identified; however, 3 (4.5%) cases were unidentifiable due to the low number of parasites. Seventeen metabolites were expressed by the metacyclic forms of L. major, L. tropica and C. fasciculata isolates. The top differential metabolites expressed more in C. fasciculata were FAD, p-Methoxybenzyl alcohol and S-b-G-5, 5-G-b-S (A = CH2) (P<0.005) whereas Veratryl glycerols and D-(+)-Mannose were significantly increased in L. major and Betulin, L-Tyrosine in L. tropica (P<0.01).

The invaluable techniques such as sequencing and 1H-NMR confirmed the results of genotyping of Leishmania species based on the SL mini-exon gene.  SL mini exon gene can be used as a diagnostic tool to differentiate various Leishmania genotypes and detect contamination of culture media with C. fasciculata.

Anti-tuberculosis drug-induced hepatotoxicity can result from genetic polymorphism of the isoniazid (INH) metabolizing enzyme. This study aimed to determine the effect of genetic polymorphism of N-acetyltransferase 2 (NAT2) and cytochrome P450 2E1 (CYP2E1) genes on serum isoniazid level and drug-induced hepatotoxicity.  A cross-sectional study was conducted on 120 patients (with and without hepatotoxicity) with pulmonary tuberculosis from June 2019 to April 2022 in Tehran (Iran). High-performance liquid chromatography was used to measure the serum concentration of INH and acetylisoniazid (AcINH). NAT2 and CYP2E1 genotypes were determined using polymerase chain reaction and restriction fragment length polymorphism methods. Data were analyzed using SPSS software (version 22.0) with independent two-sample t test, Chi square test, or Fisher’s exact test. P<0.05 was considered statistically significant. A total of 40 patients showed hepatotoxicity. The risk of anti-tuberculosis drug-induced hepatotoxicity was significantly higher in patients who are slow acetylator (SA) phenotype than in rapid or intermediate acetylator (P<0.001). NAT2*4/*4 genotypes were not found in patients with hepatotoxicity. The frequency of NAT2*5 and NAT2*6 haplotypes and serum INH concentration was significantly higher in patients with hepatotoxicity than in those without (P=0.003, P<0.001, and P<0.001, respectively). NAT2*4 haplotype was correlated with protection against hepatotoxicity. A combination of SA and CYP2E1 C1/C1 genotype was significantly associated with hepatotoxicity (P<0.001).  Hepatotoxicity in Iranian patients with tuberculosis was confirmed due to the presence of NAT2 SA polymorphism. Determining NAT2 and CYP2E1 genotypes and/or INH concentration can be a valuable tool to identify patients susceptible to hepatotoxicity.

Extracellular vesicles (EVs) may accelerate cell death during the course of infection. Mycobacteria could invade the host’s immune system and survive in the host by modulation of miRNAs. MiRNAs' differential expressions can serve as biomarkers. This study evaluates THP-1 monocyte cell death by EVs from serum of patients with mycobacteria and assesses serum-derived exosomal miRNAs to increase or decrease THP-1 monocyte cell death. EVs were purified from serum of patients with mycobacteria and cultured with THP-1 monocyte. The cell death was determined via annexin V-FITC and PI staining. The microRNA was isolated from serum-derived EVs of the patients. Expression level of Hsa-miR-20a-5p, Hsa-miR-29a, Hsa-miR-let7e, and Hsa-miR-155 was assessed using qRT-PCR. Cell death was accelerated in 10 and 5 µg/ml concentrations of the EVs (p<0.05). Minimum cell death was seen in 2.5 and 1.2 µg/ml concentrations (p<0.05). In tuberculosis (TB) patients, expression of miR-20a-5p, miR-29a, and miR-let7e were significantly enhanced (p≤0.0001), but miR-155 expression reduced. ROC analysis showed diagnostic biomarkers of miRNAs with an AUC=0.6933 for miR-20, AUC=0.6011 for miR-29a, AUC=0.7322 for miR-let7e, and AUC=0.7456 for miR-155 for active tuberculosis. Expression of miR-let7e, 20a, and 29a in M. avium vs. M. tuberculosis was overexpressed (P≤0.01, P≤0.0001, and P≤0.0001, respectively). Also miRs let7e and 20a expression was accelerated in M. abscessus vs. M. tuberculosis (P≤0.0001 and P≤0.002, respectively). EVs accelerates cell death and may not be ideally considered for drug delivery and vaccine developments. Circulating exosomal microRNA MiR-20, miR-let7e, and miR-155 facilitate development of potential biomarkers of pulmonary tuberculosis and non-tuberculosis.

Although many aspects of the COVID-19 disease have not yet been clarified, dysregulation of the immune system may play a crucial role in the progression of the disease. In this study, the lymphocyte subsets were evaluated in patients with different severities of COVID-19. In this prospective study, the frequencies of peripheral lymphocyte subsets (CD3+, CD4+, and CD8+ T cells; CD19+ and CD20+ B cells; CD16+/CD56+ NK cells, and CD4+/CD25+/FOXP3+ regulatory T cells) were evaluated in 67 patients with confirmed COVID-19 on the first day of their admission. The mean age of patients was 51.3 ± 14.8 years. Thirty-two patients (47.8%) were classified as severe cases, and 11 (16.4%) were categorized as critical. The frequencies of blood lymphocytes, CD3+ cells, CD25+FOXP3+ T cells, and absolute count of CD3+ T cells, CD25+FOXP3+ T cells, CD4+ T cells, CD8+ T cells, and CD16+56+ lymphocytes were lower in more severe cases compared to the milder patients. The percentages of lymphocytes, T cells, and NK cells were significantly lower in the deceased patients. (p= 0.002 and p= 0.042, p=0.006, respectively). Findings of this cohort study demonstrated that the frequencies of CD4+, CD8+, CD25+FOXP3+ T cells, and NK cells differed in the severe cases of COVID-19. Moreover, lower frequency of T cells and NK cells could be predictors of mortality in these patients.

COVID-19, caused by SARS-CoV-2, requires new approaches to control the disease. Programmed cell death protein (PD-1) and cytotoxic T-lymphocyte–associated protein 4 (CTLA-4) play important roles in T-cell exhaustion in severe COVID-19. This study evaluated the frequency of whole blood lymphocytes expressing PD-1 and CTLA-4 in COVID-19 patients upon admission to the intensive care unit (ICU) (i.e., severe) or infection ward (i.e., moderate) and after 7 days of antiviral therapy. COVID-19 patients were treated with either favipiravir or Kaletra (FK group, 11 severe and 11 moderate) or dexamethasone plus remdesivir (DR group, 7 severe and 10 moderate) for 7 days in a pilot study. Eight healthy control subjects were also enrolled. The frequency of PD-1+ and CTLA-4+ lymphocytes in whole blood was evaluated by flow cytometry. Patients on DR therapy had shorter hospital stays than those on FK therapy. The frequency of PD-1+ lymphocytes in the FK group at baseline differed between COVID-19 patients and healthy controls, while the frequency of both PD-1+ and CTLA-4+ cells increased significantly 7 days of FK therapy. The response was similar in both moderate and severe patients. In contrast, the frequency of PD-1+ and CTLA-4+ lymphocytes varied significantly between patients and healthy controls before DR treatment. DR therapy enhanced PD-1+ but not the CTLA-4+ frequency of these cells after 7 days. We show that the frequency of PD-1 and CTAL-4-bearing lymphocytes during hospitalization was increased in Iranian ICU COVID-19 patients who received FK treatment, but that the frequency of CTLA-4+ cells was higher at baseline and did not increase in patients who received DR. The effectiveness of DR treatment may reflect differences in T-cell activation or exhaustion status, particularly in CTLA-4-expressing cells.

 This study aimed to investigate the etiology and contributing factors of cavitary pulmonary lesions in HIV infected patients. 

 In this study, 844 HIV infected patients with a total of 1000 admissions were investigated at Masih Daneshvari Hospital from Aug 2010 to Oct 2019. After excluding the missing data and distorted documentation, 746 cases and 878 admission episodes finally underwent statistical analysis. The CXRs were observed thoroughly and the cavitary lesions were identified. Eventually, demographic data, diagnostic information, and laboratory findings were extracted and analyzed.

 Of the 878 episodes of hospitalization, cavitary pulmonary lesions were observed in 145 documents. The most prevalent etiology was TB with 105 cases (72.5%). After that, Pneumocystis jiroveci and septic embolism were responsible for a further 7.6% and 5.6% of the total lung cavities, respectively. 58.5% of the cavities were present in a single lobe, with men being affected in 90.2% of the cases. The upper lobes were the most common site of involvement in the lungs [42.9% for Left Upper Lobe (LUL) and 52.3% for Right Upper Lobe (RUL)]. The rate of definitive diagnosis was significantly higher in patients affected with cavitary lesions (82.8%) in comparison with the unaffected (74.8%) (p=0.001). No significant difference in demographics, HIV and ART status, CD4+ cell count, viral load, and mortality was evident between the two groups. 

 The most common etiology of cavitary lesions in HIV positive patients was attributable to TB, PJP, and septic embolism respectively. Cavitary lesions were more prevalent in males and mainly tend to involve the upper zones of pulmonary parenchyma.

Diagnosis and treatment of patients with multidrug-resistant tuberculosis (MDR-TB) are very important. Hence, it is necessary to predict and diagnose these patients based on individual, demographic and clinical characteristics before starting treatment. This study aimed to predict MDR-TB in TB patients using the perceptron artificial neural networks (ANNs) model.

This retrospective cohort study was conducted on 1,050 TB patients who have been treated in Masih Daneshvari Hospital, Tehran, Iran from 2005 to 2015. Data on personal and demographic information, as well as medical data such as drug therapy, final outcome of treatment, and the diagnosis of MDR-TB, were collected from the patients' medical records.

The results of this study indicated that the predictive power of MDR-TB for both training and testing groups was 85% and 80%, respectively. Also, the variables of marital status, education, drug use, being imprisoned, extrapulmonary TB, history of comorbidities, AIDS, patients' age, and family size were identified as very effective factors. However, variables of residence, smoking history, contact with a TB person, pulmonary TB, drug side effects, nationality, and diabetes were found as effective factors in predicting the development of MDR-TB.

Application of the perceptron ANNs model in the study of MDR-TB is able to create new horizons in the diagnosis of these patients due to high predictive accuracy.

 Carbapenem-resistant Enterobacteriaceae (CRE) are rapidly growing, which makes it vital to detect antibacterial activity. However, the carbapenem family does not have an automated antimicrobial susceptibility testing card. So the aim of this study was to identify the prevalence of carbapenemase-producing strains of Gram-negative bacteria and determine their antibiotic susceptibility pattern in Tehran, Iran.

 In this cross-sectional study, between 2019 and 2020, 1600 samples were taken from the Masih Daneshvari hospital's laboratory in Iran. Utilizing standard biochemical methods, all isolated bacteria were identified. The common Kirby-Bauer Disc diffusion method was used for antimicrobial susceptibility testing. A real-time polymerase chain reaction was used to evaluate the molecular detection of genes producing carbapenemase.

Of 1502 (94.7) Gram-negative bacilli, 37.3% isolates were Pseudomonas aeruginosa, 30.6% Acinetobacter baumannii, 16.5% Klebsiella, 9.3% Escherichia coli, 0.6% Pseudomonas multophila, 0.4% Neisseria1105 (73.5%) isolates were carbapenem-sensitive, while the remaining 397 (26.5%) isolates were carbapenem-resistant. Molecular testing of this sample showed that 80% of tested isolates had resistance genes to at least one antibiotic resistance gene. The following carbapenemase genes were most frequently detected among resistant strains: blaimp (35%), blavim (20%), blakpc (15%), blaoxa -48 (10%), blandm (10%), and blages (10%).

 From this study authors can conclude that carbapenemase-producing Enterobacteriaceae is increasing in Iran and the use of phenotypic methods for detection of CPEs showed good sensitivity. Before prescribing antibiotics to patients, this test should be performed.

Today, due to progressing technology and improving the standard of living of humans, the study of diseases has become more complex. This complexity has led to using new methods, such as the model of artificial neural networks (ANNs), to study many chronic diseases, especially tuberculosis (TB). The present study aimed to investigate the mechanism of disease relapse events by applying a multilayer perceptron artificial neural network (MLP-ANN) model among TB patients.

This retrospective cohort study examined information of 4,564 TB patients treated in Masih Daneshvari Hospital, Tehran, Iran, from 2005 to 2015. TB disease relapse was considered as a study event, and the relapse mechanism was investigated using an MLP-ANN model consisting of three layers.

Based on an MLP-ANN model comprising three layers, the power to accurately predict disease relapse in TB patients was 96%. Also, variables of family size, adverse effects of exposure to cigarette smoke, patient age, and education as very effective factors, and marital status, history of drug use, imprisonment, pulmonary TB, diabetes, and AIDS as effective factors were identified in predicting the mechanism of TB disease relapse.

Using an ANN model in the study of TB relapse due to its flexibility and high predictive accuracy can clarify any ambiguous aspects of this disease.

 Coronavirus disease 2019 (COVID-19) is an acute respiratory syndrome that despite global health efforts to prevent its spread, it still has high fatality rates in many countries.

Based on the medical information of 4,372 COVID-19 patients referring to Dr. Masih Daneshvari Hospital in Tehran, Iran, the case-fatality rate (CFR) for COVID-19 was calculated, and the trend of this index was assessed using the artificial neural network (ANN) model.

In this study, the CFR for COVID-19 reduced by an average of 0.4% per day and reached 4.43% during 50 days of the epidemic onset. Predicting the daily trend of this index using ANN model also showed a very gentle downward trend. According to the prediction of this model, during the first 100 days and also the second 100 days from the COVID-19 epidemic onset, the CFR for this disease decreased by an average of 0.03% and 0.01% per day, and reached 3.87% and 3.05%, respectively,

The use of CFR for COVID-19 and prediction of the trend of this index for the future can provide valuable information on the diagnosis of the disease severity and evaluation of the effectiveness of control and treatment strategies, as well as assessment of the health care.

Diabetes and immunosuppressive diseases have been reported as increased risk factors for developing invasive pulmonary tuberculosis and mucormycosis.

Case report: 

We presented here a case of a 55-year-old uncontrolled diabetic male with rhinosinus mucormycosis and pulmonary TB coinfection. Maxillary and ethmoid sinus involvement was observed in paranasal computed tomography. His chest computed tomography showed tree in the bud sign and cavitary lesions in the lungs. Mycobacterium tuberculosis was confirmed through molecular diagnosis using a realtime polymerase chain reaction assay. The nasal cavity biopsy revealed the fungal elements (aseptate hyphae) and confirmed mucormycosis infection. Amphotericin B liposomal, teicoplanin, and tazobactam were administered to treat the mucormycosis. The patient was successfully treated with a recommended four-drug regimen for TB without any adverse reaction.

The clinicians must consider tuberculosis and mucormycosis tests when confronted with an uncontrolled diabetic patient with clinical symptoms of hemoptysis, fever, and cavitary lesions.

Despite the clinical and epidemiological importance of Mycobacterium simiae worldwide, including in Iran, there is no clear and effective treatment regimen for M. simiae and its different subtypes.

Concerning the superiority of molecular approaches, this study aims to identify the common M. simiae subtypes submitted to the National Reference Tuberculosis (TB) Laboratory of Iran and study the presence of drug resistance by molecular detection methods.

We included sputum samples with M. simiae confirmation submitted to the National Reference TB Laboratory of Iran from May 2014 to May 2016. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay was used for drug susceptibility testing (DST).

Among 7200 TB suspected patients, a total of 60 M. simiae cases belonging to subtype I were identified. All the included clinical isolates met the American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) diagnostic criteria and were considered the disease’s causative pathogen. Males (58.33%), elderly (68.54%), and patients with a history of TB (51.42%) were shown to be more prone to infection with the disease. All clinical isolates of M. simiae were resistant to rifampin (RIF) and isoniazid (INH). Amikacin/kanamycin (AMK/KAN) and ciprofloxacin (CIP) susceptibility was found to be 91.66% and 88.33%, respectively.

Subtype I was exclusively identified among M. simiae patients in Iran. Molecular detection of drug resistance suggests that amikacin/kanamycin and ciprofloxacin could be used to treat patients infected with M. simiae subtype I.

The success of treatment strategies to control the disease relapse requires determining factors affecting the incident short-time and long-time of disease relapse. Therefore, this study was aimed to identify the factors affecting of short-and long-time of occurrence of disease relapse in patients with tuberculosis (TB) using a parametric mixture cure model.

In this historical cohort study; the data was collected from 4564 patients with TB who referred to the Tuberculosis and Lung Diseases Research Center of Dr. Masih Daneshvari Hospital from 2005 to 2015. In order to evaluate the factors affecting of short-and long-time of occurrence of disease relapse, a parametric mixture cure model was used.

In this study, the estimation of the annual incidence of TB relapse showed that the probability of recurrence in the first year is 1% and in the third and tenth years after treatment is 3% and 5%, respectively. In addition, the results of this study showed that the variables of residence, exposure to cigarette smoke, adverse effects of drug use, incarceration, and pulmonary and extra- pulmonary tuberculosis were the factors affecting the short-time recurrence of TB. The variables of drug use, pulmonary and extra- pulmonary tuberculosis, and also incarceration affected the long-term recurrence of this disease.

Cure models by separating factors affecting the short-time occurrence from the long-time occurrence of disease relapse can provide more accurate information to researchers to control and reduce TB relapse.

 The development of treatment methods and increasing the survival of patients with tuberculosis (TB) has led to the complication of relationships between independent and dependent variables associated with this disease. Therefore, it is important to use new methods to model the TB process that can accurately estimate the current situation. This study aimed to model the survival of patients with tuberculosis based on the model of perceptron artificial multilayer neural network (MLP-ANN).

In this retrospective cohort study, the data was collected from 2366 TB patients who were treated in Dr. Masih Daneshvari Hospital in Tehran from 2005 to 2015. To model the predictive power of survival in TB patients, an MLP-ANN model consisting of three layers was applied.

The results of this study showed that based on the MLP-ANN model, the correct predictive power of survival in TB patients is 88.4%. In this study, the variables of patients' age and family size as very effective variables also variables of patients’ gender, marital status, education, adverse drug effects, exposure to cigarette smoke, imprisonment, pulmonary tuberculosis, and AIDS as effective variables in predicting the survival of patients were diagnosed.

In the model of artificial neural networks, no restrictions are considered for the data structure and the type of relationship between variables. Therefore, these models with their flexibility and high accuracy can be one of the best methods for modeling health data.

Human monkeypox virus (MPXV) is a double-stranded DNA virus of the Orthopoxvirus genus of the Poxviridae family. Two genetic clades of the monkeypox virus have been identified: West African and Central African.

Despite the fact that about two years have passed since the onset of the  COVID-19 pandemic, there is still no curative treatment for the disease. Most cases of COVID-19 have mild or moderate illness and do not require hospitalization. This   guideline   released   by   the   National   Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital COVID-19 Expert Group to provide a treatment guide for outpatient management of COVID-19.

Returning symptomatic patients with a history of recovered COVID-19 with a new positive SARS CoV-2 PCR test after several weeks to months of a negative PCR result is challenging during the COVID-19 pandemic.

We aimed to determine such Iranian patients’ clinical and laboratory characteristics and discuss possible reasons.

We retrospectively investigated SARS CoV-2 PCR tests in three referral hospitals. All patients who had the following criteria were included in the study: two SARS CoV-2 PCR-positive tests three months apart, no symptoms, a negative PCR test between the two positive tests, and access to the patient and medical information. Then, we retrospectively recorded the clinical and laboratory characteristics of the eligible patients. We also compared the clinical and laboratory features in the first and second episodes.

Among 1,899 patients, 37 cases were eligible in the study based on our criteria. The majority of patients were males and nurses. The mean age was 37.54 ± 15.16 years. Weakness, myalgia, and fever were the most frequent clinical symptoms in both episodes. The mean interval between discharge and second presentation was 117 ± 61.42 days. The clinical, radiological, and laboratory characteristics were not significantly different between the two episodes, except for significantly more dexamethasone use in the second episode (P = 0.03).

We could not cultivate the virus and perform the phylogenic sequencing of SARS-CoV-2; however, the prolonged interval between the two episodes suggests probable reinfection in our cases. Finally, this clinical phenomenon may be more common in HCW without a significant consequence; however, most cases were HCW who had more compatibility with our criteria due to the availability of their medical information

The study aimed to evaluate the effectiveness and safety of BAE in TB patient with massive hemoptysis and evaluate the recurrence rate of hemoptysis after BAE.
In this prospective study, 68 patients with moderate and severe hemoptysis due to active or old tuberculosis who underwent bronchial arteriography were included. CXR and CT scan were performed in all patients. Selective and nonselective bronchial artery angiography was performed in all patient and 62 patients underwent embolization.
Thirty-two patients (47.1%) had active TB and 36 patients (52.9%) had inactive TB (post-tuberculosis sequelae). Abnormality was detected in a single vessel in 30 (44.1%) patients, in two vessels in 23 (33.8%) and in more than two vessels in 13 (19.1%) patients. Embolization was performed in 62 patients and overall 95 abnormal arteries were embolized. Hemoptysis control rate was 82.3% at one month, 73.5% at three months, 69.1 % at 6 months, 63.2% at one year and 60.3% after two years.
No major complication occurred as a result of BAE procedures. BAE is a safe and effective method for the management of hemoptysis in patient with tuberculosis. Only 20.6% of the patients need to repeat BAE during 2 years of follow up.