فهرست مطالب ronak miladi

Crimean-Congo hemorrhagic fever (CCHF) is a contagious viral disease that can be transmitted through various means, including tick bites, contact with infected blood and animal tissues in slaughterhouses, and healthcare-related infections.

In this study, we examined the incidence of CCHF and analyzed the demographic and clinical data of 130 patients diagnosed with CCHF in Kermanshah, a city located in western Iran, over a period of 15 years (2006 - 2020).

During the study, 19 cases tested positive, 66 were verisimilar, and the remaining cases (31.54%) were considered suspected. Among the positive cases, 15 patients recovered, and four died. Of those infected, 63.16% were males residing in rural areas. Additionally, 78.95% of the infected individuals had contact with domestic livestock, 26.31% had a history of contact with ticks, and 10.53% had contact with raw meat or raw liver. Furthermore, 5.26% had a history of contact with a CCHF patient.

The highest prevalence of CCHF was observed among men aged 15 to 30 who lived in rural areas. According to the annual reports of people suffering from CCHF, health authorities should prioritize this disease in their public health programs. Since individuals who come into direct contact with livestock and livestock products are at a high risk of contracting diseases, it is important to educate them.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters cells through angiotensin converting enzyme  2 (ACE2), which expression of its gene increases during pregnancy that is resulted in an enhanced level of the ACE2  enzyme. It might enhance the risk of SARS-CoV-2 infection and its complications in the pregnant women. Although,  pregnancy hypertensive disorders and severe infection with SARS-CoV-2 are correlated with high comorbidity, these  two entities should be discriminated from each other. Also, there is a concern about the risk of preeclampsia and  consequently severe coronavirus disease 2019 (COVID-19) development in the pregnant women. So, to answer these  questions, in the present review the literature was surveyed. It seems there is higher severity of COVID-19 among  pregnant women than non-pregnant women and more adverse pregnancy outcomes among pregnant women infected  with SARS-CoV-2. In addition, an association between COVID-19 with preeclampsia and the role of preeclampsia  and gestational hypertension as risk factors for SARS-CoV-2 infection and its complications is suggested. However, infection of the placenta and the SARS-CoV-2 vertical transmission is rare. Various mechanisms could explain the role of COVID-19 in the risk of preeclampsia and association between preeclampsia and COVID-19. Suggested mechanisms are included decreased ACE2 activity and imbalance between Ang II and Ang-(1-7) in preeclampsia, association of both of severe forms of COVID-19 and pregnancy hypertensive disorders with comorbidity, and interaction between immune system, inflammatory cytokines and the renin angiotensin aldosterone system and its contribution to the hypertension pathogenesis. It is concluded that preeclampsia and gestational hypertension might be risk factors for SARS-CoV-2 infection and its complications.

 Staphylococcus aureus is an opportunistic pathogen, which often causes asymptomatic diseases. This bacterium could cause several disorders, ranging from skin infections to life-threatening diseases. S. aureus could also develop resistance to a wide range of antibiotics.

 The present study aimed to investigate the prevalence and pattern of antibiotic resistance in isolated S. aureus in Imam Reza Hospital of Kermanshah, Iran.

 This descriptive cross-sectional study was conducted on 2,228 patients with a positive S. aureus culture who were admitted to Imam Reza Hospital during 2016 - 2018. In accordance with the CLSI protocol, bacterial isolates were separated using laboratory tests, and antibiotic susceptibility was assessed using the standard disk-diffusion method. Data analysis was performed in SPSS version 24.

 Most of the S. aureus-positive cases were isolated from the emergency ward (43.7%), blood samples (40.1%), and urine samples (23.9%). The highest antibiotic resistance was observed against erythromycin, penicillin G, ofloxacin, cefoxitin, clindamycin, and piperacillin. With 93.3% and 81.8% sensitivity, vancomycin and teicoplanin were respectively the most effective antibiotics against S. aureus.

 According to the results, the prevalence of resistant S. aureus strains could be due to the long-term hospitalization of patients and the overuse of antibiotics in infection treatment. Therefore, proper monitoring and development of effective infection control methods are essential in these healthcare settings.

 Although coronavirus disease 2019 (COVID-19) is a respiratory disease, it seems that liver abnormalities are also prevalent in the patients.

 The present study aimed to evaluate liver enzymes in COVID-19 patients.

 This descriptive, cross-sectional study was conducted on 111 COVID-19 patients admitted to Imam Reza Hospital in Kermanshah during September-November 2020. The required data were extracted from the hospital files, and data analysis was performed in the Excel software and SPSS version 21.

 The mean age of the patients was 60.87 ± 15.85 years. 50.5% of patients were female. Among the patients, 38.7% had hypertension, 19.8% had diabetes, and 7.2% had cardiovascular diseases. Moreover, 34.2% of the patients had abnormal aspartate aminotransferase (AST), 17.1% had abnormal alanine aminotransferase (ALT), and 100% had abnormal lactate dehydrogenase (LDH).

 According to the results, hypertension, diabetes, and cardiovascular diseases were the most common comorbidities among the COVID-19 patients. AST, ALT, and LDH are important indicators of hepatic disorders, which were abnormal in these patients as well. Moreover, the patients aged less than 60 years, male patients, and those with renal disorders had a higher mean ALT.

COVID-19 is a worldwide health problem. Although the most infected patients experience a mild-to-moderate disease, some patients (especially older people) develop pulmonary distress with fatal lung failure and multi-organ damage. There is currently no known effective treatment for this disease. Sofosbuvir, an FDA-approved drug for the treatment of hepatitis C virus, is also able to inhibit other members of positive strand RNA viruses with conserved polymerase and may be helpful for the treatment of SARS-CoV-2. The goal of the current trial is to determine the usefulness of “standard of care (SOC) plus hydroxychloroquine and lopinavir/ritonavir” vs. “SOC plus a combination of lopinavir/ritonavir hydroxychloroquine and sofosbuvir/velpatasvir” in patients hospitalized with COVID-19.

 In this randomized controlled trial, patients over 18 years who have been diagnosed with COVID-19 by the positive SARS-CoV-2 reverse transcriptase–polymerase chain reaction (RT–PCR) test or compatible chest computed tomography (CT) scan were candidates for the study. Eighty patients from Kermanshah province, West of Iran were allocated to treatment with SOC plus hydroxychloroquine and lopinavir/ritonavir (dual therapy) or SOC plus a combination of hydroxychloroquine and lopinavir/ ritonavir and sofosbuvir/velpatasvir (triple therapy) for 10 days. Allocation was conducted using simple randomization. The primary outcomes were reducing mortality up to 28 days after hospitalization. Adverse events were handled and reported in accordance with the Good Clinical Practice guidelines. Participants: Patients who were hospitalized with COVID-19 (with positive SARS-CoV-2 RT–PCR test and/or compatible chest CT scan) were screened for eligibility at Farabi Hospital, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran.

Both arms received active treatment and none was given placebo. The intervention arm received hydroxychloroquine 400 mg single dose and lopinavir–ritonavir (400 and 100 mg) twice daily plus sofosbuvir–velpatasvir (400 and 100mg) once daily orally, plus SOC for 10 days. The comparator arm received hydroxychloroquine 400 mg single dose and lopinavir–ritonavir (400 and 100 mg) twice daily orally, plus SOC for 10 days. SOC includes oxygen therapy, non-invasive and invasive ventilation, antibiotic agents, vasopressor support, renal-replacement therapy, and corticosteroids.

The main outcomes are reducing mortality until 28 days after hospitalization. Other outcomes can be found in full protocol file. Randomization: For the purpose of allocation sequence generation, using an Excel file (randomnumbers table) and simple random allocation, 80 included patients entered to the study, 40 patients in each group (1:1 ratio). In order to maintain the allocation sequence concealment, the details of treatment for each patient were contained in a sealed envelope, labeled by the numbers from 1 to 80. In fact, our study was a randomized open label clinical trial in which all the physicians and nurses plus all patients were aware of the type of treatment. Blinding: Our study was a randomized open label clinical trial in which all the physicians and nurses plus all patients were aware of the type of treatment. Numbers to be Randomized (Sample Size): Eighty included patients entered to the study, 40 patients in each group using simple random allocation. Trial Status: The finalized protocol version 1.5 was used in the trial study and the recruitment/intervention process started on April 11, 2020, finished on May 11, and the related follow-up finished on June 8, 2020.

This clinical trial has been registered on March 30, 2020 under IRCT number 46790, in the Iranian Registry of Clinical Trials (https://www.irct.ir/ trial/46790) and by KUMS under Grant No. 990097. Full Protocol: The full protocol and other details are attached as a Supplementary File (full protocol), accessible from the journal website. Preliminary Data: The sofosbuvir/velpatasvir regimen does not improve survival, clinical improvement, and duration of hospitalization in hospitalized COVID-19 patients.

Some studies show a chest CT scan to be superior to reverse transcription-polymerase chain reaction (RT-PCR) studies for diagnosis of COVID-19. This study was designed to assess the prevalence of COVID-19-related lung involvement in patients admitted to our trauma center. In this retrospective study, data from a referral trauma center were reviewed from February 21, 2020, to April 10, 2020. All patients admitted to the hospital for whom a chest CT scan was performed for any reason during the study period were included. Trained physicians screened all CT scans for findings suggestive of COVID-19. Next, blinded radiologists selected CT scans with findings highly suggestive of COVID-19 involvement. The clinical course and outcome and the results of PCR for SARS-CoV-2 were recorded and assessed. A total of 4200 chest CT scans were reviewed. After multiple rounds of exclusion, 24 patients with highly- suggestive findings were reviewed. Only three patients developed COVID-19 symptoms during the course of admission. PCR results were positive in 22 patients (92.6%). We recommend chest CT scans in trauma patients at a high risk of COVID-19 infection, as well as those requiring extensive surgical interventions. Also, a thorough review of the available CT scans before invasive procedures, preferably with the help of an expert radiologist, is highly recommended, even when the results of the COVID-19 laboratory tests are negative.

Antibiotic resistance is spreading worldwide against the Gram-negative bacteria that cause nosocomial infections.

The present study aimed to determine the antibiotic resistance pattern of Enterobacter isolated from the blood, urine, wound, and sputum samples of the patients referring to Imam Reza Hospital in Kermanshah, Iran.

This descriptive, cross-sectional study was conducted on 649 patients with positive Enterobacter cultures at Imam Reza Hospital during 2016 - 2018. The isolates were obtained using laboratory tests based on the CLSI protocol. In addition, the standard disc-diffusion method was used to assess antibiotic susceptibility. Data analysis was performed in SPSS version 20.

Most cases of positive Enterobacteriaceae were isolated from the patients admitted to the intensive care unit (35.6%) and emergency ward (21.9%), as well as the urine (51.6%) and sputum samples (20.5%), respectively. Levofloxacin, ciprofloxacin, and imipenem were the most effective antibiotics against Enterobacter with the susceptibility of 56.7%, 54.8%, and 53.3%, respectively.

According to the results, the antibiotic resistance of Enterobacter to ampicillin and ceftriaxone was high, and these antibiotics must be used correctly and reasonably. Furthermore, more epidemiological studies are required in Iran to provide national programs for preventing the spread of antibiotic resistance.

Acinetobacter is a gram-negative coccobacillus, which is widespread in nature and causes several nosocomial infections, such as pneumonia, meningitis, endocarditis, skin and soft tissue infections, conjunctivitis, and bacteremia. Acinetobacter has also demonstrated resistance against multiple antimicrobial agents.

The present study aimed to investigate the antibiotic resistance pattern of the isolated Acinetobacter strains from the patients admitted to various wards of Imam Reza hospital in Kermanshah, Iran.

This descriptive, cross-sectional study was performed on 726 patients with positive Acinetobacter cultures at Imam Reza hospital during 2016 - 2018. Bacterial isolates were identified using laboratory tests and based on the CLSI protocol, and the standard disc-diffusion method was used assess antibiotic susceptibility. Data analysis was performed in SPSS version 20.

Most of the Acinetobacter-positive cases were isolated from the intensive care units (75.88%) and sputum (73.3%) and urine samples (10.1%). In addition, the highest and lowest resistance rate of the isolates was observed against ceftriaxone (96.6%) and ampicillin-sulbactam (58.7%), respectively.

According to the results, the bacterial isolates were multiple-drug resistant and showed resistance to ciprofloxacin, ceftazidime, cotrimoxazole, ceftriaxone, cefepime, gentamicin, imipenem, ampicillin, ampicillin-sulbactam, and  amikacin. The high resistance to imipenem is rather alarming as it is considered the ’last resort’ in the treatment of the infections caused by gramnegative bacteria. Therefore, monitoring programs are recommended to prevent the misuse of this drug in hospitals.

 The main pathogen causing various nosocomial infections, especially in burn patients, is Staphylococcus aureus. An important virulence factor of this bacterium is leukocidin, which binds to white blood cells and leads to apoptosis and necrosis.

 In the present research, we aimed at investigating the prevalence of the panton-valentine leukocidin (PVL) and LucED genes in methicillin-susceptible and resistant isolates of S. aureus isolated from burn patients in Kermanshah, Iran.

 Overall, 73 isolates of S. aureus were collected from burn wounds and identified by specific biochemical tests. After determining the susceptibility patterns of the isolates by the disc diffusion method, the frequencies of the PVL and LucED genes were assessed using specific primers and polymerase chain reactions.

 The rates of methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-susceptible Staphylococcus aureus (MSSA) isolates were 58.9% (43 isolates) and 41.1% (30 isolates), respectively. In MRSA isolates, the highest antibiotic resistance was to penicillin (100%) and gentamicin (81.4%). Moreover, the frequencies of the LucED and PVL genes were 76.7% (56 isolates) and 27.4% (20 isolates), respectively, and the highest frequency of the LucED and PVL genes was observed in MRSA (81.4%) and MSSA (40%) isolates, respectively.

 Increased multidrug resistance pattern among S. aureus isolates with leukocidin production has led to treatment failure and severe infections. The development of infections can be prevented by the identification of isolates carrying the leukocidin gene, and early detection of MRSA isolates is feasible by using the PVL gene.
 

 Coronaviruses are a large family of RNA viruses, which range from the common cold virus to the causative agent of more severe diseases. Coronavirus was declared a pandemic in December 2019 in Wuhan, China. Iran has been an endemic zone for the spread of the coronavirus since the outset of this global epidemic and has remained among the countries largely affected by high rates of the disease.

 The present study aimed to investigate the range of the chest computed tomography (CT) scan findings among the hospitalized patients with COVID-19 in Kermanshah, Iran during March-April 2020 to contribute to the accurate diagnosis of the infected patients.

 The sample population consisted of 286 hospitalized patients diagnosed with or suspected of the coronavirus disease. Chest CT-scan images and clinical data were reviewed, and their correlation was analyzed.

 In total, 176 patients (61.53%) were male, and 110 (38.47%) were female. The mean age of the patients was 56 years. Polymerase chain reaction (PCR) results showed that 35.31% of the cases had coronavirus, while the results were negative in 64.69% of the cases. In addition, the CT-scan findings indicated 77.27% abnormal and 22.73% normal chest CT-scans. Among the patients, 75.87% recovered completely, and 18.53% died. The major CT abnormalities were diffuse ground-glass opacification (35.66%), peripheral ground-glass opacification (bilateral; 21.33%), and a combination of diffuse and peripheral ground-glass lesions (18.88%). The consolidation lesion of one lobe was detected in 16 patients, and the consolidation lesion of more than one lobe was observed in 40 patients.

 According to the results, the most common chest CT-scan findings in COVID-19 include diffuse ground-glass opacification, peripheral ground-glass opacification (bilateral), central ground-glass opacification (bilateral), a combination of diffuse and peripheral ground-glass opacification, a combination of central and peripheral ground-glass opacification, the consolidation lesion of one lobe, and the consolidation lesion of more than one lobe. Furthermore, significant correlations were observed between the CT-scans and the main clinical symptoms, while no significant correlations were denoted between the chest CT-scan and PCR results.

 Nosocomial infections are important medical concerns in developed and developing countries. Pseudomonas aeruginosa is considered the third leading cause of nosocomial infections following Staphylococcus aureus and Escherichia coli.

 The present study aimed to determine the antibiotic resistance of isolated P. aeruginosa strains in the patients admitted to Imam Reza Hospital in Kermanshah, Iran.

 This descriptive, cross-sectional study was conducted on 900 patients with positive P. aeruginosa cultures who were admitted to Imam Reza Hospital in Kermanshah, Iran during 2016-2018. Bacterial isolates were separated using laboratory tests, and the standard disc-diffusion method was used to assess antibiotic susceptibility based on the CLSI protocol. Data analysis was performed in SPSS version 24.

 The majority of the P. aeruginosa-positive cases were isolated from the emergency ward (44.3%), intensive care unit (21.9%), blood samples (40.4%), and urine samples (18.7%). The highest antibiotic resistance was observed against cotrimoxazole, ceftriaxone, ampicillin, ampicillin-sulbactam, nitrofurantoin, nalidixic acid, cefazolin, and cefixime. In addition, ciprofloxacin and imipenem were the most effective antibiotics against P. aeruginosa with the sensitivity of 68.1% and 57.2%, respectively.

 According to the results, P. aeruginosa had high resistance against antibiotics such as cotrimoxazole and ceftriaxone. Therefore, these antibiotics should be used correctly and reasonably, and epidemiological studies in this regard should be focused on proposing national programs to prevent the further spread of antibiotic resistance.

Vitamin D insufficiency and HIV infection are both risk factors for chronic disorders. Several studies on small groups of male HIV-infected patients have reported alterations of calcium and bone metabolisms. This study aimed to evaluate serum levels of vitamin D, magnesium, calcium, iron, and TIBC in HIV-infected patients compared with controls in the west of Iran.
In a case-control study approved by the Ethics Committee of Kermanshah University of Medical Sciences, 98 prisoners with HIV and 98 controls were selected in 2016. Age, sex, vitamin D, calcium, magnesium, iron and total iron binding capacity (TIBC) were checked for all participants in both groups. Also, CD4 was checked in all HIV-infected patients.
The mean age ± SD (range) of HIV-infected and control groups was 40.11 ± 7.73 (21.68) and 45.59 ± 18.61 (18.85) years, respectively. Vitamin D, calcium, iron, and TIBC levels were significantly different in these two groups (P This study showed that calcium, iron and TIBC levels were significantly higher in HIV-infected patients compared with those in the control group. Moreover, vitamin D insufficiency and deficiency were higher in HIV-infected patients. The patients with CD4 500 cells/mm3