shabnam tehrani

 Disseminated nocardiosis is a rare but life-threatening infectious disease that occurs most often in immunocompromised individuals. This report presents a human immunodeficiency virus (HIV)-infected patient with disseminated nocardiosis in the liver, lung, and brain.

 A 38-year-old woman who had recently been diagnosed with HIV infection complained of fever, abdominal pain, productive coughs, and occasional headaches from 2 months ago. Imaging findings of her abdomen and lungs displayed evidence of pyogenic liver abscess and lobar pneumonia with abscess formation, respectively. The patient underwent percutaneous liver abscess drainage and bronchoalveolar lavage (BAL). Using reverse transcription-polymerase chain reaction (RT-PCR), the genome of Nocardia farcinica was detected in the specimens obtained from both procedures. Besides, she had seizures during hospitalization. Based on cerebrospinal fluid (CSF) analysis, the specimen was positive for N. farcinica. Brain imaging also revealed evidence of multiple bacterial abscess formation. She was diagnosed with disseminated nocardiosis and treated with intravenous imipenem, trimethoprim/sulfamethoxazole, and amikacin, followed by appropriate oral agents. After a 6-month follow-up, the patient had no symptoms. Additionally, the lesions improved on brain imaging.

 Patients who are HIV-positive are particularly prone to opportunistic infections. Health care providers should consider all pathogens, even rare ones, like Nocardia spp., to establish a diagnosis if they're present. Furthermore, in cases initially diagnosed with localized nocardiosis, other body organs should also be reviewed so that the disseminated form of the disease can be diagnosed and treated immediately.

Labial adhesion (LA) is rarely observed in postmenopausal women. There is no uniform consensus regarding the etiology of the LA, yet. It may present with different urinary or vaginal symptoms. We herein report the clinical symptoms, management and follow-up of eight postmenopausal patients with LA and a brief review of the literature.

We reported the presenting complaints, treatment and surgical outcomes of eight postmenopausal patients, diagnosed with LA. The mean age and follow-up were 55 years (range: 42-69) and 27 months (range:18-36), respectively. All patients were either virgins or did not have sexual intercourse for years. The increasing number of adults LA case reports highlights the importance of conducting a thorough genital examination in all females with hypoestrogenic state and voiding complaints, especially those who are not sexually active. Placing separate absorbable sutures at the introitus area, prolonged use of topical estrogen and maintaining sexual contact or vaginal cones may help to reduce the early recurrence.

The surgical technique can be considered a safe, effective and durable method for the treatment of LA in postmenopausal women.

 To report the first case of ocular syphilis in an Iranian patient and discuss its diagnostic challenges.

Case Report:

 A man in his mid-70s presented with progressive bilateral visual and auditory decline. He had previously lived in a Southeast Asian country for 10 years. Prior steroid therapies entailed no inflammation subsidence. His visual acuity at presentation was light perception OU. Funduscopic findings included severe vitritis, severe optic atrophy, diffuse retinal vascular occlusion, and diffuse retinal atrophy OU. Angiography demonstrated diffuse areas of retinal and choriocapillaris atrophy with no active choroiditis. Scaly cutaneous lesions were noted on his palms and soles – atypical findings of secondary syphilis. Serum analysis revealed an underlying syphilis infection. The cerebrospinal fluid sample was reactive to anti-syphilis antibodies, securing a neurosyphilis diagnosis. Two weeks of antibiotic therapy resulted in cutaneous lesions resolution and relative visual improvement despite extensive baseline retinal atrophic damage.

Ocular syphilis can mimic numerous ocular inflammatory scenarios. In cases of ocular inflammation that is unresponsive to steroids, reconsidering alternative diagnoses, especially infections with the highest clinical relevance, is necessary. We stress the importance of acquiring patients’ sexual history, regardless of cultural barriers and the rarity of the entity in some regions.

One of the major health problems in the intensive care unit (ICU) is the nosocomial infection caused by multidrug-resistant (MDR) pathogens. The antimicrobial stewardship program (ASP) is a solution to prevent antibiotic resistance. This study aimed to determine the impact of an antimicrobial stewardship program onthe frequency of drug-resistant bacteria in an ICU.

This quasi-experimental study was conducted between 2019 and 2021 in Labbafinejad Hospital, Tehran, Iran. This study consisted of two time periods: 1) one year with no restriction of antibiotic prescription (before ASP), and 2) one year with restriction ofantibiotic prescription based on the stewardship program (after ASP). We obtained demographic and clinical characteristics of patients from their medical records. Standard disk diffusion and broth microdilution were used to determine the antibiotic susceptibility of bacterial pathogens isolated from the patients.

A total of 300 ICU-admitted patients were included in the study (150 for each period). We found out that the total length of hospitalization, length of hospitalization in ICU, and treatment duration were lower after ASP (P=0.022, P=0.383, and P<0.001, respectively). Also, the frequency of antibiotic resistance, including MDR and Vancomycin-Resistant Enterococci (VRE) strains, decreased significantly after performing ASP (P=0.013). However, in terms of mortality, there was no significant difference between the two periods (P=0.236).

The results of our study highlight the implementation of the antibiotic Stewardship program and the rational use of antibiotics in the ICU setting to inhibit the spread of antibiotic-resistant bacteria.

Since the emergence of coronavirus disease 2019 (COVID-19), many people have been vaccinated worldwide. Despite the preventive role of vaccines, their side effects face disease management with challenges. This study aims to investigate the side effects of COVID-19 vaccination among healthcare workers in Tehran, Iran.

This cross-sectional study was conducted from April to October 2022 on 377 healthcare workers in Tehran, Iran. Data collection was carried out through an interview by a researcher using a checklist assessing systemic and local side effects of COVID-19 vaccines.

The mean age of participants was 36.03±10.24 years, and 68.2% were female. Participants experienced significantly more local (26.5% vs. 14.3%, P<0.001) and systemic (52.0% vs. 31.8%, P<0.001) side effects after the first dose than after the second dose. After the first dose, AstraZeneca (45.9%) caused significantly more local reactions than Sputnik V (21.7%) and Sinopharm (14.5%). AstraZeneca (83.7%) caused significantly more systemic side effects than Sputnik V (50.7%) and Sinopharm (14.5%). The prevalence of local and systemic side effects after the first dose was significantly different in terms of vaccine types (P<0.001). After the second dose, AstraZeneca (20.4%) caused significantly more local reactions than Sputnik V (12.8%) and Sinopharm (10.5%) (P<0.001). Additionally, AstraZeneca (38.8%) and Sputnik V (37.4%) caused significantly more systemic side effects than Sinopharm (7.9%) (P<0.001).

Most healthcare workers in Tehran experienced flu-like symptoms and local reactions at the injection site after vaccination against COVID-19, mainly after the first dose. They had more side effects after vaccination with AstraZeneca and Sputnik V, compared to Sinopharm.

In late December 2019, a series of unexplained cases of pneumonia were reported in Wuhan, China. On January 12, 2020, the World Health Organization temporarily named the virus responsible for the emerging cases of pneumonia as the 2019 coronavirus. Acute respiratory distress syndrome (ARDS) due to Covid-19 has rapidly spread around the world, and while no specific treatment or vaccine has been reported, mortality rates remain high. One of the suggested treatments for cellular damage in the pathogenesis of ARDS caused by the coronavirus is the administration of high doses of intravenous vitamin C. Considering the paucity of literature on the therapeutic effects of high doses of intravenous vitamin C in patients with ARDS resulting from the coronavirus, this study was conducted to assess this therapeutic supplement in these patients.

 This study was performed as a single-center clinical trial in patients with a documented diagnosis of COVID-19 pneumonia. 54 eligible patients with moderate to severe COVID-19 symptoms, based on specific inclusion and exclusion criteria, were included in the investigation and randomly divided into two groups. The control group consisted of 26 patients who received standard treatment, whereas the treatment group was comprised of 18 patients administered intravenous vitamin C at a dose of 2 g every 6 hours for 5 days in addition to standard treatment. Demographic characteristics, underlying diseases, length of hospital stay, and mortality rates were reviewed and collected. Oxygen saturation, respiratory rates, serum C Reactive Protein (CRP) levels, lymphopenia and lung parenchymal involvement on CT were investigated at the time of admission and on the sixth day after hospitalization. Finally, all variables were analyzed with IBM SPSS Statistics 23 software and a significant statistical difference was defined for all variables, P <0.05.

 Of these variables, the amount of oxygen saturation in the vitamin C group increased significantly from 86±5% on the first day of hospitalization to 90±3% on the sixth day of hospitalization (P value=0.02). Also, the respiratory rate in the vitamin C group decreased significantly from 27±3 on the first day of hospitalization to 24±3 on the sixth day of hospitalization (P value=0.03). Lung CT scans of patients in the two groups reported by two radiologists were also compared. Based on the report of the radiologists, the rate of lung involvement in the vitamin C group was significantly lower than in the control group at the end of treatment (P value=0.02).

 Due to the effectiveness of high doses of intravenous vitamin C on reducing lung involvement and improving clinical symptoms, further studies with a larger sample size are recommended to demonstrate the effects of this drug supplement.

Since the coronavirus disease 2019 (COVID-19) pandemic began, several vaccines have been manufactured to subside it. This study aimed to determine the prevalence of side effects after injecting common COVID-19 vaccines available in Iran.

This cross-sectional study was accomplished on Shahid Beheshti University of Medical Sciences (Tehran, Iran) employees during January and September 2022. Eligible participants were selected based on the simple ran- dom method and interviewed about side effects after injecting COVID-19 vaccine.

The mean age of 656 participants was 38.03 ± 9.53 years, and 453 (69.1%) were female. The prevalence of post-vac- cination side effects was higher after receiving the first dose (53.2%) than the second (35.9%) and third (49.4%) doses. Across all three vaccine doses, the overall proportion of side effects was higher following AstraZeneca than the others. The most common side effect after the first dose of the vaccine was myalgia (41.9%), followed by fever (36.6%), chills (31.6%), local reactions (27.0%), headache (25.5%), and sweating (21.6%). People experienced mainly myalgia (23.3%) and fever (20.3%) after injecting the second dose of the vaccine. Additionally, the participants had myalgia (37.2%), fever (30.8%), chills (29.2%), local reactions (26.0%), and headache (24.4%) after the third dose of the vaccine.

AstraZeneca had a higher proportion of post-vaccination adverse effects than Sputnik V, Pastocovac, and Sin- opharm. The most common side effects were flu-like syndrome and local reactions at the injection site. Furthermore, people rarely experienced life-threatening side effects. Thus, the available COVID-19 vaccines in Iran are safe.

 Polymyositis is an idiopathic inflammatory myopathy that mainly manifests itself with muscle weakness. Patients with polymyositis have a higher risk of developing infections and malignancies. We report concurrent pulmonary and cerebral lesions in a polymyositis patient with many diagnostic challenges.

 A 56-year-old woman complained of a productive cough and dyspnea from two weeks ago. Her symptoms gradually progressed until a sudden loss of consciousness occurred. She was a known case of polymyositis and was treated with oral prednisolone. Imaging revealed concurrent pulmonary and cerebral lesions. Initially, the patient underwent empirical therapy. However, the patient underwent a bronchoscopy because she did not respond to treatment. Specimens obtained from respiratory secretions revealed branched septate hyphae, and the culture was positive for Aspergillus fumigatus. She was diagnosed with invasive aspergillosis, so we replaced the therapy with voriconazole. After three months, the lung lesions improved, but the number and extent of cerebral lesions increased. Finally, after a stereotactic biopsy, the patient was diagnosed with astrocytoma and became a candidate for radiotherapy.

 Patients with polymyositis are prone to contracting opportunistic infections and malignancies. Both of them can mimic each other and present diagnostic challenges to physicians. Thus, they should think about them for early diagnosis and timely treatment.

Colistin is a common antibiotic used to treat urinary tract infections (UTIs) caused by gram-negative bacteria. In recent years, due to the increasing resistance, consumption of colistin alone could lead to treatment failures. This study aimed to compare the effectiveness of colistin alone with colistin and meropenem to treat patients with urinary tract infections.

In this randomized, open-label, parallel groups controlledtrial, hospitalized patients with urinary tract infections were included. Patients were randomly allocated to the control group (n=35) that received colistin (1 mIU every 12 hours) and the intervention group (n=35) that received colistin (1 mIU every 12 hours) with meropenem (1gr every 8 hours). An infectious diseasespecialist evaluated the therapeutic responses 48-72 hours after admission. Cessation of fever, improvement of symptoms and signs, and negative urine culture within 48 hours wereconsidered successful therapeutic responses.

The mean length of hospitalization was longer in the control group (4.74±0.78 days) compared with the intervention group (4.26±0.56 days) (P=0.004). The prevalence of fever cessation had no significant difference between the two groups at any time (P>0.05). Also, there was no significant difference between the two groups at any time, considering vital signs, irritative urinary symptoms, nausea and vomiting, and flank pain (P>0.05).

The administration of colistin and meropenem to treat UTIs was associated with a shorter length of hospital stay. However, regarding response to treatment, it did not matter if they were treated with colistin alone or with combination therapy (colistin and meropenem).

Due to uncontrolled lymphocyte reaction, the overproduction of cytokines in COVID-19 patients can cause sepsis-like symptoms, suggesting sepsis, cytokine release syndrome (CRS), and secondary hemophagocytic lymphohistiocytosis (sHLH). Since different therapeutic approaches are used for each diagnosis, differentiation is essential. This study aims to use H-score as a possible prognostic tool in COVID-19 patients.

A sample of 64 moderate and severe COVID-19 patients was enrolled in this study. Clinical and laboratory findings were assessed. H-score was initially calculated and reevaluated among severe cases 72 hours later and among moderate cases showing severe features of COVID-19.

Mortality of 31.3% was reported. Laboratory findings, including triglycerides (TG), ferritin, and aspartate aminotransferase (AST) showed significantly higher initial and follow-up laboratory assessment levels in severe cases than in moderate cases. Moreover, fibrinogen was significantly higher among severe cases than moderate cases at the initial assessment, but no significant difference was reported in the second fibrinogen assessment.

In this study, H-score was useful as a predictive tool for the initial evaluation of severe cases of COVID-19. H-score is much lower in these patients than in non-COVID-19 HLH patients may be due to the different underlying immunologic pathophysiology of COVID-19; thus, each H-score criterion must be evaluated for sensitivity and specificity in COVID-19 patients. The H-score cut-offs, H-score may be useful for diagnosing immune overreaction and determining the need for more exclusive immunomodulatory treatments

 This study aimed to determine carbapenems, colistin resistance genes, and antimicrobial susceptibility profiles of Pseudomonas aeruginosa and Acinetobacter baumannii isolates.

 In this cross-sectional study, specimens of patients with bloodstream, urinary tract, and surgical site nosocomial infections were enrolled. P. aeruginosa and A. baumannii isolates were identified using conventional methods. Antimicrobial susceptibility testing (AST) on isolates was performed using the disk diffusion method and minimum inhibitory concentration (MIC) for colistin as recommended by the Clinical and Laboratory Standards Institute (CLSI). The combination meropenem disk method was used to detect metallo-β-lactamases (MBLs). The blaNDM, blaVIM, blaIMP, and mcr-1 genes were identified using the polymerase chain reaction (PCR) method and Sequencing.

 Forty strains of P. aeruginosa and forty strains of A. baumannii were isolated from hospitalized patients. The overall prevalence of multidrug-resistance (MDR) was 50% and 95% in P. aeruginosa and A. baumannii isolates, respectively. Almost all the MDR isolates were resistant to cefepime and piperacillin. Colistin had significant inhibitory activity against the isolates. MBL was detected in 25.0% and 15.0% of clinical isolates of P. aeruginosa and A. baumannii, respectively. We detected no blaNDM, blaVIM, blaIMP, and mcr-1 genes in our A. baumannii isolates. Moreover, only three P. aeruginosa isolates were positive for blaIMP gene.

 The alarming proportion of MDR P. aeruginosa and A. baumannii isolates was reported in the current study. Effective infection prevention practices are required and AST should guide patients' treatment.

We compared two common antibiotic regimens for the treatment of mild to moderate CAP: levofloxacin versus β-lactam and macrolide combination; in terms of their efficacy and side effects.

Patients with mild to moderate CAP were randomized into two groups. Group I received a combination of 1 gram ceftriaxone daily and 500 mg azithromycin daily for 5-7 days. Group II received levofloxacin 750 mg daily for five days. The signs and symptoms, hospitalization length, and the side effects were investigated.

There were 77 and 74 patients in groups I and II. The vital signs of group II were significantly better on the 3rd day of admission, except for the temperature (P=0.09). The O2 saturation of group II was markedly improved on the 5th day of admission (P=0.0061). In terms of clinical symptoms and hospitalization length, group II was considerably better. However, the rate of side effects in both groups was similar (P=0.885).

Hospitalized patients with mild to moderate CAP might take more advantage of fluoroquinolone administration. It could improve the patients' signs and symptoms and reduce hospitalization length, compared with the combination of macrolide and cephalosporin, with the same rate of side effects.

Brucella prosthetic joint infection is a rare condition. We report a case of bilateral prosthetic knee joint infection caused by Brucella melitensis, which was cured by prolonged antibiotic therapy without implant removal.

A 62-year-old woman was admitted to the Labbafinejad Hospital (Tehran, Iran), complaining of pain and swelling in her knee joints from two months ago. She was also suffering from intermittent fever and night sweats. She underwent bilateral total knee arthroplasty five years ago because of a severe degenerative joint disease. Agglutination tests (wright and 2-mercaptoethanol (2-ME)) were positive. Her knee joint fluid and blood cultures yielded B. melitensis. The polymerase chain reaction result from her knee joint fluid was positive for Brucella spp. The patient was cured after combination therapy with doxycycline, rifampin, and gentamicin. The prosthesis was retained due to the lack of loosening in radiography. Ten months after the treatment, the patient had no symptoms and could walk with no pain.

Clinicians should consider brucellosis in the differential diagnosis of prosthetic joint infection in the endemic regions. They should also be aware that if patients have no sign of implant loosening, they can achieve favorable outcomes only by using antibiotics and with no need for implant removal.

In late 2019, severe acute respiratory syndrome- coronavirus-2 (SARS-CoV-2) was reported in Wuhan, China. This virus spread quickly worldwide, with millions of victims until now. The clinical manifestations of the novel coronavirus disease (COVID-19) are a broad spectrum, from asymptomatic and mild cases with a flu-like syndrome to severe cases requiring intensive care1. The severity of diseases and risk of mortality is higher in the elderly, which most authorities attribute to underlying conditions, including diabetes, hypertension, cardiovascular diseases, and respiratory diseases. However, some neglected factors, such as cytomegalovirus (CMV) reactivation, can affect patient outcomes2.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) spread widely all around the world and has infected too many healthcare workers (HCWs) as the pioneers combating coronavirus disease 2019 (COVID-19). This study aims to evaluate the symptoms and outcome of medical staff from a tertiary hospital in Tehran, Iran. The diagnoses of 29 HCWs presenting COVID-19 symptoms were confirmed by molecular and imaging studies. Epidemiologic and disease-related data were collected via phone calls and filling a questionnaire and then analyzed descriptively. Eighteen (62.1%) of the affected HCWs were males. The mean age of them was 41.86 years with a lower average (38.27) for females than males. Nurses comprised 41.4% of our population. Only 2 (6.9%) patients were admitted to the respiratory care unit (RCU) (), marked as critical patients. The most presented symptoms were fever (79.3%) and dyspnea (79.3%).  Overall, 55.2% of them had a longer exposure time (more than a week), which was more frequent in men than women. Fever was the most prevalent symptom among the study group. Even though the clinical features of COVID-19 among HCWs cannot be copiously determined by this study, it highlights the requirement for comparative studies to illustrate differences among HCWs and the general population. There might be an association between the duration of the exposure and the risk of the infection in men.

Coronavirus disease 2019 (COVID-19) is a concern in the medical community as the virus spreads around the world. It has a heavy global burden, particularly in low-income countries. This virus has its specific outcomes in each population. Hence, it is necessary to design studies to find the epidemiological behaviour of this virus.

This cross-sectional study was conducted in the Labbafinezhad hospital, Tehran, Iran. Demographic features include age, sex, past medical history, drug history, habitual file, influenza vaccination history, recent exposure history, clinical symptoms or signs, and the recorded symptoms. The clinical examination and para-clinical assessment, including chest computed tomography (CT) and laboratory testing on admission, were recorded.

It was found that patients with a history of kidney transplantation, high level of LDH, high level of AST, and increased neutrophil to lymphocyte ratio are most at risk of death.

Parameters mentioned could help practitioners predict patient outcomes, and necessary interventions could be considered in this regard.

Urinary tract infection is an important cause of nosocomial infections. The purpose of this study was to determine the bactereuria and antimicrobial susceptibility by Epsilometer test (E-test) method among the patients hospitalized in Labafinejad hospital, Tehran, Iran.

In this observational descriptive cross-sectional study, 84 consecutive hospitalized cases in Labbafinejad hospital during the years 2017-2018 were enrolled, and the antimicrobial susceptibility among them was determined by E-test method based on the Clinical and Laboratory Standards Institute (CLSI).

The resistance to gentamicin, ampicillin, colistin, ciprofloxacin, ceftriaxone, vancomycin, imipenem, and meropenem was seen in 31.0%, 54.5%, 14.9%, 45.9%, 50.0%, 33.3%, 66.7%, and 25.7%, respectively.

According to the obtained results in this study, it may be concluded that antibiotic resistance to imipenem, ampicillin, ceftriaxone, and ciprofloxacin is significantly high in nosocomial UTI cases, and development of strategies is required to improve the treatment course.

Currently, clinical details of immunosuppressed patients suffering from COVID-19 are limited. Some studies have shown no more severe diseases among them, but others have highlighted that immunosuppressed patients may have high levels of viral load and impaired immune responses. Herein, this study aimed to specifically address the symptoms, prognosis, laboratory tests, clinical course, and the outcome of SARS-CoV-2 infected immunocompromised patients at a tertiary referral center.

Clinical and laboratory information of 75 non-congenital immunosuppressed patients with COVID-19 disease was obtained at a referral center for immunodeficiency diseases and infectious disorders in Tehran, Iran. Three groups of immunocompromised patients were evaluated, including patients with a history of organ transplantation, autoimmune patients receiving medical therapy, and cancer patients undergoing chemotherapy.

Among 75 immune-deficient patients with COVID-19, there were 32 patients with a kidney transplant, 23 patients with malignancies, and 19 patients with autoimmune disorders. One patient had both malignancy and multiple sclerosis. The mean length of hospitalization was 10.82 days. By the end of the study, 24 (32%) patients were dead, and 51 (68%) patients were discharged. Dyspnea was the most common (64%) symptom. Low levels of O2 saturation and lymphopenia at admission time significantly affected the mortality rate of patients.

This study showed that mortality rate among immunocompromised patients was 32%. It seems that COVID-19 has a worse outcome and a more severe clinical course in immunocompromised patients regardless of age, gender, and underlying diseases.

Severe symptoms of COVID-19 could be actually life-threatening and fatal. No effective treatment has been proposed yet. Plasma from COVID19 recovered patients may be effective according to past similar studies of some other viral infections.Materialsand

This study was conducted at the infectious disease ward of Shahid Labbafi Nejad Hospital (Tehran, Iran) from 3rdof April 2020 up until 3rdof May 2020. Clinical information for the 12 patients, before and after receiving convalescent plasma transfusion was obtained from a review of the hospital computer medical system retrospectively and analyzed.

Out of 12 patients with Covid-19 who received convalescent plasma, 7 patients were male (58.3%) and 5 were female (41.7%). The mean age of the patients was 52 years. Among them, 50% (n=6), improved and discharged and the rest of them died. Mean O2saturation of patients with final outcome of death and discharged before plasma therapy were 67 (33%) and 77 (83%), respectively, animprovement, defining partial resolution of lesions of chest CT scan or stop in progression of infiltrations was detected in all of 6 discharged patients.

Convalescent plasma may have effective role in improving O2saturation, lymphopenia and CT scan lesions and also decreasing inflammatory factors of cases with severe manifestations but could not change prognosis for critically ill patients. Therefore, an early administration of convalescent plasma may be helpful

The COVID-19 is a family of large enveloped non-segmented positive-sense RNA viruses which was first reported in December 2019 in Wuhan, China with a cluster of unexplained pneumonia. Although various medications have been tried to manage the COVID-19 pandemic, there is no exclusive medication or vaccine so far. In this study, we aimed to focus on the effectiveness of Hydroxychloroquine + Kaletra (lopinavir/ritonavir) versus Hydroxychloroquine + Sofosbuvir in patients hospitalized with COVID-19 to given the urgent need for an effective drug against SARS-CoV-2 in the current pandemic context.

Fifty-four eligible patients with moderate to severe COVID-19 symptoms, according to the WHO criteria entered the study. Patients were randomized into two treatment groups. Thirty-two patients received Hydroxicholoroquine (400 mg stat) and Kaletra (400/100 mg q 12 h) as a control group (group A) and the trial group of 22 patients, received Hydroxicholoroquine (200 mg q 12 h) plus Sofosbuvir (400 mg daily) (group B) for a period of 7 to 14 days. Eventually, collected data included demographic characteristics, underlying diseases, clinical symptoms, laboratory data, and mortality were analyzed.

There was no significant difference in age, sex, and underlying diseases between the two groups. There was no significant statistical difference between the two groups on the seventh day of treatment in terms of cough relief, leukocyte count, and improvement of lymphopenia however in terms of the time of defervescence of fever, there was a significant difference between the two groups.

Therefore, it can be said that our study is one of the first studies in the world to evaluate the effectiveness of sofosbuvir in the treatment of patients with COVID-19. According to our results, although Kaletra was assumed as an effective therapy, its superiority over Sofosbuvir was confined to the earlier effervescence of the 7-day fever and sofosbuvir can be used as an effective treatment, especially in patients with underlying heart disease who are at risk for arrhythmias with Kaletra.

Ventilator-Associated Pneumonia (VAP) occurs in hospitalized patients who have undergone intubation and mechanical ventilation for more than 48 hours. Patients referred to the Intensive Care Unit (ICU) are also affected by VAP due to specific conditions, especially by Gram-negative pathogens with advanced drug resistance. In this study, the pattern of antibiotic resistance of gram negative bacteria isolated from tracheal culture of VAP patients was investigated in ICU.

In this cross-sectional study, tracheal samples were collected from VAP patients admitted in the hospital's ICU from March 2017- February 2018. After isolation, bacterial isolates were identified using biochemical tests. Then, antimicrobial resistance pattern of these isolates was investigated using standard disc diffusion and E-test methods. Multiplex PCR were used to detect the blaOXA-23-like, blaOXA-51-like, blaOXA-24-like, and blaOXA-58-like genes among Acinetobacter baumannii (A. baumannii) isolates.

A total of 29 bacterial isolates were isolated from ICU patients, which were A. baumannii, Pseudomonas aeruginosa (P. aeruginosa), Klebsiella pneumoniae (K. pneumoniae) and candida spp, with prevalence of 38, 27.5, 13.8, and 20.7%, respectively. Antibiotic susceptibility test of isolates indicated that almost all isolates showed Multi-Drug Resistance (MDR) pattern. The A. baumannii isolates were resistant to ciprofloxacin and piperacillin-tazobactam, but ampicillin-sulbactam and colistin had better results. Ciprofloxacin, meropenem and colistin were effective against P. aeruginosa isolates, but other antibiotics were less effective and Colistin, Levofloxacin (LVX) and Piperacilin/Tazobactam were the best antibiotics that were effective on the isolates of K. pneumonia.

According to the present study, high resistance to most antibiotics in gram negative bacilli showed that antibiotic therapy should be based on the type of bacteria isolated by tracheal culture and, as far as possible, combination therapies should be used to maximize the coverage of other possible pathogens, and antibiotic resistance in ICU.

Fascioliasis is a zoonotic disease caused by liver flukes of the genus Fasciola, as F. hepatica, and F. gigantica, mainly affecting the liver and biliary system during the chronic phase. These trematodes migrate through biliary ducts results in mild inflammation, when it is difficult to distinguish from obstructive lesions. Here we describe a 53-yr-old man from Golpayegan, a city in Isfahan Province, Iran, in year 2015, with occasional fever and chills, and also frequent colicky abdominal pain mainly on the right upper quadrant, with tenderness at that part. There was no jaundice and elevated bilirubin, but increased alkaline phosphatase was detected. Dilated common bile duct on abdominal sonography, without any visible lesion at its end and also dilated intra- and extrahepatic biliary ducts on abdominal CT-scan were seen. Endoscopic Retrograde Cholangiopancreatography (ERCP) detected incarceration of parasites behind Oddi's sphincter and also in common bile duct and serologic test (ELISA) confirmed fascioliasis. However, Iran is one of the most affected countries by Fasciola, being aware of rare symptoms and presentations of this disease can aid the physicians to make timely and accurate diagnosis and therefore reduce the consequent morbidities.

Cytomegalovirus (CMV) infection has been reported in ulcerative colitis (UC), but limited data are available on its prevalence in Iran. The aim of this study was to evaluate the prevalence of CMV infection in patients with UC. A prospective, cross-sectional study was conducted in 86 consecutive patients with UC. Prevalence of CMV infection was determined by rectal biopsies for hematoxylin and eosin staining and PCR. CMV-positive specimens was measured for CMV loads by real-time PCR assay. In six out of 86 (7%) patients with UC, CMV was diagnosed. These patients had detectable CMV DNA in their biopsies as indicated by PCR. In all CMV-positive patients, viral load was more than 250 copy/mg. Histochemical staining did not show any CMV inclusion bodies. No significant demographic and clinical differences existed between patients with and without a CMV infection. UC and its treatment may put patients at risk of CMV infection. Real-time PCR test for the detection of CMV in UC patients may enable diagnosis of CMV infection with a high sensitivity and allow effective treatment to be administered in these patients. The impact of antiviral therapy on the clinical outcome of the UC patients with CMV remains to be elucidated

Mycobacterium haemophilum is a fastidious nontuberculosis Mycobacterium that must be considered in the differential diagnosis of infections in immunocompromised patients. Mycobacterium haemophilum typically is a pathogen of the cutaneous or subcutaneous tissue and also presents as septic arthritis, osteomyelitis, pulmonary disease, and lymphadenitis. We report a 32-year-old man with past medical history of kidney transplantation, endocarditis, gastrointestinal bleeding, and hypertension, complaining of multiple painful nodular lesions since 3 months earlier. A tissue biopsy and polymerase chain reaction detected Mycobacterium haemophilum. Atypical mycobacterial species like Mycobacterium haemophilum should be assessed in immunocompromised patients positive for acid fast staining and negative for Mycobacterium tuberculosis.

Nocardia as a Gram-positive bacillus with a microscopic appearance of branching hyphae can produce considerable disease in an appropriable host. N. facinica is a member of genus Nocardia that is potentially life threatening; therefore, therapy of N. farcinica infection remains difficult.
This study is a case report of disseminated N. farcinica infection in a 64-year-old man with a history of pneumoconiosis with brain, lung, and skin involvement in Labbafi Nejad hospital, Tehran, IR Iran in November 2013 with a discussion about diagnosis and management of this particular patient.
Due to the involvement of brain, triple therapy was started with meropenem, amikacin, and linezolid.