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Koronavirove onemocněni 2019 (COVID-19) se rychle rozsiřilo po celem světě a vyvolalo globalni krizi zdravotnických systemů. Toto onemocněni dnes představuje jednu z nejzavažnějsich pandemii v historii lidstva; přitom postihuje řadu organů vcetně celeho kardiovaskularniho systemu. U pacientů s onemocněnim COVID-19 bylo popsano poskozeni myokardu, myokarditida, akutni infarkt myokardu, dysrytmie a srdecni selhani. V soucasne době neni k dispozici žadne specificke antivirotikum pro lecbu onemocněni COVID-19; zatim se použivaji některa leciva jako interferon, remdesivir, ribavirin, favipiravir a tocilizumab. Tyto latky použivane při lecbě onemocněni COVID-19 mohou mit nežadouci ucinky na kardiovaskularni system, připadně mohou interagovat s jinými farmaky urcenými k lecbě kardiovaskularnich onemocněni. Nejzavažnějsimi nežadoucimi ucinky těchto farmak jsou prodlouženi intervalu QT a torsade de pointes (TdP), ktere mohou vest k nahlemu umrti. V tomto clanku popisujeme nežadouci ucinky různých farmak na kardiovaskularni system i možne interakce mezi latkami použivanými při lecbě onemocněni COVID-19 a farmaky uplatňujicimi se v kardiologii. © 2021, CKS.

BACKGROUND: This study was aimed to investigate the risk factors for mortality in patients with COVID-19. METHODS: For this retrospective cohort study, we included 121 deceased and 436 discharged cases with COVID-19 in Babol, Northern Iran. The cases were between March 1 to April 1, 2020. RESULTS: Multivariate Poisson regression analysis revealed that older age (aRR: 1.03, 95% CI: 1.01, 1.05, p < 0.001), hospital length of stay (aRR: 0.94, 95% CI: 0.90, 0.97, p = 0.003), ICU admission (aRR: 4.34, 95% CI: 2.95, 6.37, p < 0.001), cerebrovascular disease (aRR: 1.96, 95% CI: 1.20, 3.19, p = 0.007), ventilator-associated pneumonia (VAP) (aRR: 2.09, 95% CI: 1.22, 3.55, p = 0.006), septic shock (aRR: 2.98, 95% CI: 1.44, 6.19, p = 0.003), acute respiratory distress syndrome (ARDS) (aRR: 3.80, 95% CI: 2.28, 6.31, p < 0.001), acute kidney failure (AKF) (aRR: 1.45, 95% CI: 1.12, 3.76, p = 0.021), acute heart failure (AHF) (aRR: 1.63, 95% CI: 1.01, 2.62, p = 0.043) and lymphocyte count (aRR: 3.01, 95% CI: 1.99, 4.57, p < 0.001) were associated with mortality. CONCLUSION: Findings showed that elderly with comorbidities such as cerebrovascular diseases had an increased risk of death. Some complications such as: pneumonia, septic shock, ARDS, AHF, and AKF played crucial roles as well death (Tab. 2, Ref. 25).

Eosinophilic gastroenteritis (EGE) as a rare inflammatory gastrointestinal (GI) disorder is primarily characterized by long-term or recurrent abdominal pain. Peripheral eosinophilia is usually caused by eosinophilic infiltrations into the multiple layers of the GI tract. In this report, a case of EGE with an acute abdomen is presented. A 14-year-old female experienced severe abdominal pain and hypereosinophilia. She underwent appendectomy due to severe abdominal pain approximately one week before readmission. Because of the persistence of pain, the upper GI endoscopy and biopsy were performed and the result of the pathological examination was eosinophilic gastroenteritis. Due to the nonspecificity of EGE symptoms, it is recommended that clinicians study pathology in atypical and nonresponsive GI diseases; biopsy should be performed as well.

Maternal HIV infection is related to several perinatal adverse outcomes. This study is aimed at establishing whether maternal HIV infection is associated with the development of pre-eclampsia (PE) and eclampsia. We comprehensively searched MEDLINE/PubMed, Web of Science, SCOPUS and Embase databases for relevant studies published up to 20 November 2018, without time and language restrictions. We have limited our literature searches to observational studies in humans. We applied a random-effects model to calculate the relative risks (RR) and 95% confidence intervals (CI) for the meta-analyses. We also systematically reviewed eligible studies to determine the effects of HIV infection on imbalance of angiogenic and anti-angiogenic factors, which are effective in increased risk of PE or eclampsia. We identified a total of 11,186 publications, out of which 22 eligible studies (11 prospective and 11 retrospective cohort studies) comprising 90,514 HIV-positive and 66,085,278 HIV-negative pregnant women were included in meta-analysis. Results of the meta-analyses suggested that maternal HIV infection is not significantly associated with the development of PE (RR, 1.04; 95%CI, 0.89-1.21) and eclampsia (RR, 1.05; 95%CI, 0.63-1.75). Six studies were included to understand the effects of HIV infection on imbalance of angiogenic and anti-angiogenic factors. All six studies demonstrated that HIV infection had no significant effect on expression levels of these factors in pre-eclamptic and normotensive pregnant women. Our study showed that maternal HIV infection was not significantly associated with increased or reduced risks of pre-eclampsia and eclampsia. More well-designed studies with large sample size and well defined outcomes are recommended to confirm or refute the present findings.

Children differ from adults regarding Helicobacter pylori (H. pylori) infection in many terms. H. pylori infection represents a key factor in the pathogenesis of duodenal ulcer and chronic gastritis in children. H. pylori infection causes some extraintestinal diseases as well as gastrointestinal diseases. Although, among these illnesses in children, symptoms like recurrent abdominal pain are not specific. Moreover, the role of the pathogen in the growth faltering, iron deficiency anemia, and asthma still remains controversial. A reliable method to detect H. pylori infection is a crucial issue, sand is still a matter of active debate. The tests applied for H. pylori diagnosis are grouped as either invasive or non-invasive methods. Invasive methods consist of endoscopic evaluation, the rapid urease test (RUT), histology, and bacterial culture. Non-invasive tests include the urea breath test (UBT), stool antigen test (SAT), serology, and molecular diagnostic approaches. Use of endoscopy is a pre-requisite for all invasive methods and poses difficulties in children as it is a difficult procedure and requires patient's cooperation. For this reason, the non-invasive tests have been commonly used in children, although their accuracy is not very reliable in some cases. Invasive tests may be opted to confirm the diagnosis as and when needed. This review presents the diagnostic tests used to detect H. pylori infection in children.

With the aim to analyze the clinical manifestations and outcomes of influenza, we evaluated the symptoms of proven H1N1 cases and outcomes of patients admitted to hospitals Babol University of Medical Sciences during 2015 - 2016. In this descriptive cross-sectional study, we included patients diagnosed with influenza-like illness (ILI) from October 2015 to March 2016 at hospitals affiliated to Babol University of Medical Sciences.To diagnose H1N1 infection, reverse transcription-polymerase chain reaction (RT-PCR) was performed on nasopharyngmeal swabs collected from the patients. In the current study, 123 patients were admitted due to ILI. The RT-PCR result was positive in 47.2% of patients. Symptoms such as productive cough (35.3%), sore throat (51.4%), headache (50%), dyspnea (53.2%) were comparable between PCR + H1N1 confirmed cases and H1N1 negative cases. Among the H1N1 confirmed cases, 48.3% were admitted to the intensive care unit (ICU) because of the disease severity, and 20.7% died even after receiving the therapy for several days. Among the infected cases, 20 women were pregnant, out of which three subjects died. Mortality was mostly observed in the age ˃ 50 (39%) (p = 0.03). Myalgia was significantly less observed in the group with mortality compared to other age groups (6.5% vs. 93.5%) (p = 0.005). The mortality rate of patients who received vancomycin was found to be significantly low (40%) (p = 0.01). In mortality group, the frequency of patients with creatinine levels > 1.5 mg/dL was significantly higher (58.3%) (p = 0.009) than in the group of patients who recovered. The average length of hospitalization in the mortality group was significantly longer than the hospitalization of the recovered group (11.1 days vs. 6.3 days) (p = 0.02). The current study reported a mortality rate that was more than expected in comparison to previous seasons. Our study results suggest that the absence of typical influenza symptoms such as myalgia should not cause a delay in the diagnosis of this infection in cold seasons.

The most recently discovered interferon (IFN) family, type III IFNs or lambda IFNs (IFN-λs) are caused by viral infection and act in mucosal barriers, such as the respiratory tract. In this study, we assessed the serum levels of IFN-λs in new coronavirus disease-2019 (COVID-19) patients. Sixty-four COVID-19 patients were enrolled in this study. All cases were divided into the intensive care unit (ICU) and non-ICU groups according to their symptoms. Fourteen samples of healthy controls were also included. The serum levels of IFN-λ1 and IFN-λ2 were analyzed by specific enzyme-linked immunosorbent assay (ELISA) kits. The concentrations of IFN-λ1 and IFN-λ2 induced in the serum of non-ICU patients (836.7 ± 284.6 and 798.8 ± 301.5 pg/mL, respectively) were higher than found in ICU patients (81.57 ± 34.25 and 48.32 ± 28.13 pg/mL, respectively) (P = 0.004 and P = 0.006, respectively) and healthy controls (85.57 ± 33.63 and 65.82 ± 21.26 pg/mL, respectively) (P = 0.03 and P = 0.04, respectively). Meanwhile, no significant differences were found in the concentration of both cytokines between the ICU patients and healthy controls. We conclude that higher levels of IFN-λs are associated with decreased clinical manifestations in COVID-19 patients. These cytokines could be a promising therapeutic agent to avoid the overwhelming consequences of COVID-19.

There is a limited number of clinical studies on interferon (IFN) levels in human brucellosis. The novel group of interferons, type III interferons, consists of four IFN-λ (lambda) molecules called IFN-λ1 or Interleukin-29 (IL-29), IFN-λ2 or IL-28A, IFN-λ3 or IL-28B, and IFN-λ4, are not fully known. This study is one of the first studies of IL-28A and IL-29 levels in Brucellosis cases at the end of their treatment course. A total of 33 acute Brucellosis patients were included in this study. We considered changes in the levels of IL-28A and IL-29 in cases with acute brucellosis before and after treatment with standard therapy that referred to the Ayatollah Rohani Hospital in Babol, Northern Iran. Serum IL-29 and IL-28A (acute form: 56.4 ± 30.32 and 48.73 ± 27.72, respectively, and post-treatment: 40.15 ± 20.30 and 38.79 ± 22.66, respectively) levels were elevated significantly in acute brucellosis than after treatment (p ≤ 0.05). These findings indicate that considering biomarker levels in Brucellosis patients may be indicative of the chronicity of infection. In conclusion, we suggest that IL-29 and IL-28A levels may be valuable biomarkers for follow-up patients with brucellosis.

Seasonal Influenza can cause cardiovascular complications. Therefore, this study aimed to investigate recent influenza-like illnesses (ILI) in acute myocardial infarction (AMI) patients compared to other hospitalized patients as the control group during the cold season in the north of Iran. This retrospective case-control study included 300 patients (150 AMI patients and 150 controls) aged ≥ 50 years hospitalized for acute myocardial infarction (AMI) or other conditions between September 22, 2019, and March 15, 2020. Patients in each group were frequency-matched for gender and age range. The primary exposure was a recent ILI (fever ≥ 37.8°C, cough, and sore throat) in the past month. The patients’ mean age was 64.42 ± 9.47 years, with a range of 50-94 years. Forty-five (15%) patients had diseases that met the ILI criteria. The AMI group patients significantly reported more ILI than controls (adjusted OR: 3.04, 95% CI: 1.02 to 9.09, p < 0.001). On the other hand, patients who received the influenza vaccine were significantly less likely to have an acute myocardial infarction than those who did not receive the vaccine (adjusted OR: 0.02, 95% CI: 0.001 to 0.38, p = 0.006). In conclusion, the present study demonstrates that ILI can significantly increase the risk of AMI. Also, it was confirmed that Influenza vaccination could significantly reduce the risk of AMI.

BackgroundHydroxychloroquine with or without azithromycin was one of the common therapies at the beginning of the COVID-19 pandemic. They can prolong QT interval, cause Torsade de pointes, and lead to sudden cardiac death. We aimed to assess QT interval prolongation and its risk factors in patients who received hydroxychloroquine with or without azithromycin.MethodsThis was a retrospective cohort study. 172 patients with COVID-19 included, hospitalized at hospitals of Babol University of Medical Sciences between March 5, 2020, and April 3, 2020. Patients were divided into two groups: hydroxychloroquine alone and hydroxychloroquine with azithromycin. Electrocardiograms were used for outcome assessment.Results83.1% of patients received hydroxychloroquine plus azithromycin vs 16.9% of patients who received only hydroxychloroquine. The mean age of patients was 59.2 ± 15.4. The mean of post-treatment QTc interval in the monotherapy group was shorter than the mean of post-treatment QTc interval in the combination therapy group but it had no significant statistical difference (462.5 ± 43.1 milliseconds vs 464.3 ± 59.1 milliseconds;P= 0.488). Generally, 22.1% of patients had a prolonged QTc interval after treatment. Male gender, or baseline QTc ≥ 450 milliseconds, or high-risk Tisdale score increased the likelihood of prolonged QTc interval. Due to QTc prolongation, 14 patients did not continue therapy after 4 days.ConclusionHospitalized patients treated with hydroxychloroquine with or without azithromycin, had no significant difference in prolongation of QT interval and outcome. But the number of patients with prolonged QT intervals in this study emphasizes careful cardiac monitoring during therapy; especially in high-risk patients.

There is a limited number of clinical studies on interferon (IFN) levels in human brucellosis. The novel group of interferons, type III interferons, which consists of four IFN-λ (lambda) molecules called IFN-λ1 or interleukin-29 (IL-29), IFN-λ2 or IL-28A, IFN-λ3 or IL-28B, and IFN-λ4, is not fully known. This study is one of the first studies of IL-28A and IL-29 levels in brucellosis cases at the end of their treatment course. A total of 33 acute brucellosis patients were included in this study. We considered changes in the levels of IL-28A and IL-29 in cases with acute brucellosis before and after treatment with standard therapy that referred to the Ayatollah Rohani Hospital in Babol, northern Iran. Of 33 included patients, 22 (66.6%) were males, and 11 (33.4%) were females. The range of patients’ age was 49.21 ± 17.70 years. Serum IL-29 and IL-28A (acute form: 56.4 ± 30.32 pg/mL and 48.73 ± 27.72 pg/mL, respectively, and posttreatment: 40.15 ± 20.30 pg/mL and 38.79 ± 22.66 pg/mL, respectively) levels were elevated significantly in acute brucellosis than after treatment ( p < 0.05 ). These findings indicate that considering biomarker levels in brucellosis patients may indicate the chronicity of infection. In conclusion, we suggest that IL-29 and IL-28A levels may be valuable biomarkers for follow-up patients with brucellosis.

While some biomolecules have been explored to identify potential biomarkers for prognosis of the COVID-19 prognosis, there are no reliable prognostic indicators of disease progression and severity. We aimed to evaluate the ability of the C-reactive protein (CRP) to predict COVID-19 infection. This retrospective study was conducted on 429 patients diagnosed with COVID-19 between March 30, 2020, and April 30, 2020. The study population was divided into severe cases (n = 175) and nonsevere cases (n = 254). Data on demographic characteristics, clinical features, and laboratory findings on admission were collected. The proportion of patients with increased CRP levels was significantly higher in severe cases than in nonsevere patients. Analysis of ROC curve found that CRP could be used as an independent factor in predicting the severity of COVID-19 infection. Also, patients with CRP > 64.75 mg/L were more likely to have severe complications. The serum levels of CRP can predict the severity and progression of illness in patients with COVID-19.

Background. Hydroxychloroquine with or without azithromycin was one of the common therapies at the beginning of the COVID-19 pandemic. They can prolong QT interval, cause torsade de pointes, and lead to sudden cardiac death. We aimed to assess QT interval prolongation and its risk factors in patients who received hydroxychloroquine with or without azithromycin. Methods. This study was a retrospective cohort study. One hundred seventy-two confirmed COVID-19 patients were included in this study, hospitalized at Babol University of Medical Sciences hospitals between March 5, 2020, and April 3, 2020. Patients were divided into two groups: hydroxychloroquine alone and hydroxychloroquine with azithromycin. Electrocardiograms were used for outcome assessment. Results. 83.1% of patients received hydroxychloroquine plus azithromycin vs. 16.9% of patients who received only hydroxychloroquine. The mean age of patients was 59.2 ± 15.4 .The mean of posttreatment QTc interval in the monotherapy group was shorter than the mean of posttreatment QTc interval in the combination therapy group, but it had no significant statistical difference ( 462.5 ± 43.1 milliseconds vs. 464.3 ± 59.1 milliseconds; p = 0.488 ). Generally, 22.1% of patients had a prolonged QTc interval after treatment. Male gender, or baseline QTc ≥ 450 milliseconds, or high-risk Tisdale score increased the likelihood of prolonged QTc interval. Due to QTc prolongation, fourteen patients did not continue therapy after four days. Conclusions. Hospitalized patients treated by hydroxychloroquine with or without azithromycin had no significant difference in prolongation of QT interval and outcome. The numbers of patients with prolonged QT intervals in this study emphasize careful cardiac monitoring during therapy, especially in high-risk patients.

Background. In December 2019, China has experienced an outbreak of novel coronavirus disease 2019 (COVID-19). Coronavirus has now spread to all of the continents. We aimed to consider clinical characteristics, laboratory data of COVID-19 that provided more information for the research of this novel virus. Methods. We performed a retrospective cohort study on the clinical symptoms and laboratory findings of a series of the 100 confirmed patients with COVID-19. These patients were admitted to the hospitals affiliated to Babol University of Medical Sciences (Ayatollah Rohani, Shahid Beheshti and Yahyanejad hospitals) form 25 February 2020 to 12 March 2020. Results. Nineteen patients died during hospitalization and 81 were discharged. Non-survivor patients had a significantly higher C-reactive protein (CRP) (MD: 46.37, 95% CI: 20.84, 71.90; P = 0.001), white blood cells (WBCs) (MD: 3.10, 95% CI: 1.53, 4.67; P < 0.001) and lower lymphocyte (MD: –8.75, 95% CI: –12.62, –4.87; P < 0.001) compared to survivor patients Data analysis showed that comorbid conditions (aRR: 2.99, 95% CI: 1.09, 8.21, P = 0.034), higher CRP levels (aRR: 1.02, 95% CI: 1.01, 1.03, P = 0.044), and lower lymphocyte (aRR: 0.82, 95% CI: 0.73, 0.93, P = 0.003) were associated with increased risk of death. Conclusions. Based on our findings, most non-survivors are elderly with comorbidities. Lymphopenia and increased levels of WBCs along with elevated CRP were associated with increased risk of death. Therefore, it is best to be regularly assessed these markers during treatment of COVID-19 patients.

Guillain–Barré syndrome (GBS) is an inflammatory disorder and an acute immune-mediated demyelinating neuropathy that causes reduced signal transmissions, progressive muscle weakness, and paralysis. The etiology of the syndrome still remains controversial and uncertain. GBS can be initiated and triggered by respiratory tract infections such as influenza, and intestinal infections such as Campylobacter jejuni. In addition, there is considerable evidence suggesting links between influenza vaccination and GBS. As reported previously, the incidence of GBS in individuals receiving swine flu vaccine was about one to two cases per million. Despite the influenza vaccine efficacy, its association with an immune-mediated demyelinating process can be challenging as millions of people get vaccinated every year. In this review we will discuss the association between influenza infection and vaccination with GBS by focusing on the possible immunopathological mechanisms.

Background Neonatal sepsis is accounted for 30–50% of annual neonatal deaths in developing countries. We performed a systematic review and meta-analysis study to evaluate the national prevalence and identification of the etiological pathogens of neonatal sepsis in Iran. Methods A comprehensive literature search was done on the national and international databases for studies published between 2000 and 2019. The DerSimonian and Laird random-effects model was used to calculate pooled prevalence estimates, with 95% confidence intervals (CIs). Subgroup analyses and meta-regressions regarding the gender, type of sepsis and time during were also performed. Data were extracted, analyzed, and presented according to PRISMA guideline. Results Of 944 publications identified, 22 studies containing 14,683 neonates met the eligibility criteria. The pooled national prevalence of sepsis in Iran was 15.98% (95%CI, 11.96–20.46%; 1,367/14,683). Prevalence rate in boys (20.42%; 95%CI, 9.03–34.8%) was slightly higher than girls (18.5%; 95%CI, 7.4–32.8). A decreasing trend in prevalence of neonatal sepsis was found in recent years, although not statistically significant (c = -0.005; P value = 0.4). The most prevalent causative bacterial pathogens were Enterobacter spp. (23.04%), followed by Klebsiella pneumoniae (17.54%), coagulase-negative Staphylococci (14.06%), Escherichia coli (13.92%), Pseudomonas aeruginosa (12.67%), and Staphylococcus aureus (11.48%). Conclusion Our findings showed a high prevalence of neonatal sepsis in suspected neonates, suggesting the need to implement preventive measures, routine assessment, and close monitoring of neonates. Also, Enterobacter spp. and Klebsiella pneumoniae were identified as the principal bacterial pathogens responsible for neonatal septicemia in Iran.

Helicobacter pylori (H. pylori) resides in the stomach, colonizes gastric epithelium, and causes several digestive system diseases. Several diagnostic methods utilizing invasive or non-invasive techniques with varying levels of sensitivity and specificity are developed to detect H. pylori infection. Selection of one or more diagnostic tests will depend on the clinical conditions, the experience of the clinician, cost, sensitivity, and specificity. Invasive methods require endoscopy with biopsies of gastric tissues for the histology, culture, and rapid urease test. Among non-invasive tests, urea breath test and fecal antigen tests are a quick diagnostic procedure with comparable accuracy to biopsy-based techniques and are methods of choice in the test and treatment setting. Other techniques such as serological methods to detect immunoglobulin G antibodies to H. pylori can show high accuracy as other non-invasive and invasive biopsies, but do not differentiate between current or past H. pylori infections. Polymerase chain reaction (PCR) is an emerging option that can be categorized as invasive and non-invasive tests. PCR method is beneficial to detect H. pylori from gastric biopsies without the need for the cultures. There is no other chronic gastrointestinal infection such as H. pylori with a set of comparable diagnostic methodologies. Despite the availability of multiple diagnostic methods, it remains unclear on the choice of any one method as the gold standard for detecting H. pylori infection, especially in epidemiological studies. In this work, we review the principal diagnostic methods used to detect H. pylori infection and their advantages and disadvantages, and applications in clinical practice.

In the current study, we investigated the risk factors for tuberculosis in patients admitted to the Ayatollah Rouhani Hospital in Babol, north of Iran. This cross-sectional study was conducted on 207 patients with proven tuberculosis during the years 2008-2015. Demographic data such as age and sex, smoking, history of underlying illness, illness symptoms, and laboratory results were collected and analyzed at a significant level of less than 0.05. From 207 patients, 136 were male (65.7%), 71 were female (34.3%), and 76 of them (37.3%) were smokers. It is notable that most patients (29.5%) were over the age of 71. The relation between age profile and being tuberculosis has been studied, but the co-relation was found to be not significant. The most common complaint has been coughing (60.9%). While investigating underling diseases, the most common illness has found to be Diabetes (11.3%). Based our finding, there was a significant relationship between gender and smoking with tuberculosis. Accordingly, as smoking is one of the risk factors for tuberculosis, smokers and non-smokers should be informed that smoking carries the risk for tuberculosis. Such a program should be particularly addressed to males.

Background. Regulatory T (Treg) cell plays a key role in autoimmune diseases. We evaluated the regulatory function and frequency of Treg cells and secreted IL-10, IL-35 concentration in Crohn’s disease (CD). Methods. Twenty-three patients with CD and 25 healthy controls (HC) were included in this study. We analysed the alteration of Tregs frequency using flow cytometry for CD4, CD25, CD127 and FoxP3 markers. Surface expression of CD4, CD25 and CD127 markers were used for isolation of relatively pure Treg cells. Suppressive activity of Tregs was determined by measuring their ability to inhibit the proliferation of T responder (Tres) cells. In addition, the amounts of IL-10 and IL-35 cytokines in co-culture supernatants were measured by ELISA assay after stimulation with anti-CD2/CD3/CD28. Results. CD patients had significantly lower frequency of CD4+ CD25+ CD127low FoxP3+ Treg cells in comparison with controls (2.17 ± 1.04 vs. 2.83 ± 1.07, p = 0.0352). Additionally, Treg cells mediated suppression was not significantly different in CD patients compared to controls. There was a significant difference in IL-10 secretion in response to anti-CD2/CD3/CD28 stimulation compared with HC (p = 0.0074). Conclusion. The frequency of CD4+ CD25+ CD127low FoxP3+ Tregs decreased in active stage of CD but there was no impaired suppressive function of CD4+ CD25+ CD127low FoxP3+ Treg cells. We suggest that an alteration in the balance of Tregs and T effectors may contribute to pathogenesis of CD.

Objective Urinary tract infection (UTI) is among the most common infection diseases in children with nephrotic syndrome (NS), resulting in treatment failure and relapse. No systematic reviews have estimated the prevalence of UTI in children with NS on a global scale, therefore, did the first systematic review and meta-analysis study to estimate the prevalence of UTI in children with NS in different geographical regions and different countries. Methods PubMed, EMBASE, Scopus, Web of Science and Google Scholar databases were systematically searched up to 20 February 2019, for studies assessing the prevalence of UTI in children with NS. Pooled prevalence of UTI was calculated using the random effects model. Data were stratified based on WHO geographical regions and individual countries. Subgroup analysis regarding the gender and socio-demographic variables were also performed. Results Thirty studies involving 6314 children with NS were included. The pooled prevalence of UTI was 21.6% (95%CI, 17.1–26.5%), with the highest prevalence in the African region (34.8%, 95%CI: 4.7–73.9%), and lowest prevalence in the region of the Americas (7.4%, 95% CI: 1.7–16.2%). With respect to countries, the lowest and highest prevalence rates were reported from USA (3.3%) and Indonesia (45.9%). In subgroup analyses, a higher prevalence was observed in females, and in countries with lower levels of income and human development index. The most common isolated bacteria were Escherichia coli (28%), and Klebsiella spp. (22.4%). Conclusions The high prevalence of UTI in children with NS reported in this study is a significant health threat for these patients. These results call for intervention strategies and preventive measures for children with NS to reduce the burden of UTI.

Cytomegalovirus (CMV) can cause significant inflammation. Besides, it is an important cause of pancreatitis in organ transplantations. We report a case of CMV pancreatitis in a 48-year-old male kidney transplant recipient who was admitted with elevated amylase (3 337 U/L) and lipase (1 160 U/L) enzymes, and abdominal pain. CMV infection was tested by reverse transcription polymerase chain reaction and the result was positive. CMV viremia was successfully cleared with ganciclovir. Then the absence of some of more noticeable clinical symptoms of pancreatitis may not be a decisive reason not to rule out the disease in transplanted cases.

Rationale: Strongyloides stercoralis (S. stercoralis) is an intestinal nematode with a complicated life cycle that can involve the gastrointestinal system. Infected patients are generally asymptomatic; but if symptomatic, the symptoms will include skin rash, respiratory and gastrointestinal symptoms like abdominal pain, diarrhea, nausea and vomiting. Patient concerns: A 77-year old man presented with edema of the lower extremities and insignificant tenderness in the epigastric region. Diagnosis: The histopathology of gastric tissue showed severe inflammation and multiple ulcers in the cardia, antrum and proximal duodenum. A large number of rhabditiform larvae of S. stercoralis along with tissue hyperemia and infiltration of lymphoplasma cells, eosinophils, and neutrophils were found. Intervention: Treatment with albendazole. Outcome: Despite the albendazole treatment, the patient’s condition deteriorated and eventually died because of a sepsis-like syndrome. Lesson: Physicians should remain alert to the urgency due to threadworm, especially among the elderly people and immunosuppressed cases; and should ensure accurate diagnosis, suitable treatment and careful follow-up of these cases.

The blood glucose level of people with diabetes can be normalized through an appropriate diet, physical activity, the use of chemical drugs and medicinal plants. This study aims to investigate the effects of low-calorie diets (1200, 1500, and 1800 kcal) on glucose and serum lipids in poorly controlled type 2 diabetic patients. This clinical trial was conducted among 60 patients with type 2 diabetes mellitus. The criteria for entering the study were fasting blood glucose higher than 130 mg/dl, hemoglobin A1C higher than 7% and BMI higher than 25. Blood glucose, fasting blood glucose and lipid levels were measured before and after intervention two hours after each meal. Patients were trained by an expert. Then, the questionnaires were completed and analyzed. In this study, the mean fasting blood glucose level in patients who used 1500 and 1200 kcal diet decreased significantly after intervention (p

Objective: To investigate antibiotic resistance pattern of ventilator-associated pneumonia (VAP) generating microorganisms, and quantitative culture and determining antibiotic sensitivity. Methods: This cross sectional study was performed on 50 patients suffering from VAP in intensive care unit of Ayatollah Rouhani Hospital, Babol, Iran during 2014–2015. VAP was probable for them based on clinical signs and the criteria of Clinical Pulmonary Infection Score standards. Lower respiratory samples were given under bronchoalveolar lavage and quantitative culture was done on them. Afterwards by microdilution method, minimal inhibitory concentration based on respective microorganisms, considering clinical pulmonary infection score were determined. Results: From 50 investigated samples in this study, the most common microorganisms were Acinetobacter baumannii (A. baumannii) (70%) then Pseudomonas aeruginosa (12%), Staphylococcus aureus (8%) and Klebsiella pneumonia (3%). In our study A. baumannii showed approximate 100% resistance to all antibiotics, in a way that A. baumannii resistance to imipenem and meropenem and piperacillin/tazobactam each was 97.1%. The most resistance of Pseudomonas aeruginosa was 66.7% to each cefepime and ceftazidime and clavulanate/ticarcillin. Staphylococcus aureus showed 75% resistance to nafcillin, cloxacillin and resistance in case of vancomycin was not seen. Conclusion: In current study, A. baumannii had the most prevalence among VAP and this species is resistant to most of antibiotics. Using ceftazidime, cefepime and clavulanate/ticarcillin, in treatment of the patients suffering VAP is not reasonable.

Leptospirosis is a zoonosis that common in warm and tropical regions with global spread and it is an occupational disease. The aim of recent study was to evaluate the clinical and Para clinical findings of leptospirosis patients in Babol, northern of Iran. In this cross-sectional study, 118 patients with high suspicion to leptospirosis admitted to hospitals of Babol University of Medical Sciences, Babol, Iran, during 2009 -2011. Thirty one cases with positive finding (IFA) were enrolled as definitive Patients. Clinical and Para clinical data for all patients were recorded. The mean age of the confirmed ‎patients (male: 71%, rural: 90.5%) was 48.5 years (range 18-80 years old). The commonest chief complaints were fever (71%) and ichter (19%) and among the clinical features of them fever (90.5%), gastro intestinal signs (80.5%), ichter (71%) and headache(68%) was the most prevalent ones. Weil's syndrome occurred in 10 (32%) patients. Thrombocytopenia and leukocytosis were noticed in 80.5% and 42% of the patients respectively. Transaminases in 80.5% of cases were above the normal upper limit. Based on current study, the most of leptospirosis patients were farmers and presented in hot seasons. The commonest clinical and laboratory pattern of this disease in our region was fever, ichter, myalgia and headache in conjunction with Mild elevations in levels of transaminases and thrombocytopenia that can be used as a good marker in early clinical diagnosis and treatment.

Leptospirosis is a common disease between humans and animals. Identifying common serogroups and comparing different clinical symptoms among them can help in finding the clinical pattern associated with pathogen serogroupes of leptospirosis. Therefore, the purpose of this study has been to investigate the common serotypes of the infection and their clinical symptoms in northern Iran. This cross-sectional study was carried out in educational hospitals of Babol University of Medical Sciences during the years 2011- 2014. Subjects with clinical findings consistent with leptospirosis were included in the study. According to the standard MAT guidelines, the titre >=1: 200 was considered positive. Then, the patients identified by serogroup separation, were examined and compared clinical symptoms. Among 6o patients with primary diagnosis of leptospirosis in this study, 35 of them proved to be infected to the disease. The most common serogroups were serjoe (40%) and icterohemorrhagia (31.4%). Autumnalis (22.8%), grippotyphosa (11.4%), canicola (8.6%), and pomona (2.8%) were included the subsequent serogroups. The highest frequency of fever (28%) and gastrointestinal manifestations (36%) were observed in icterohemorrhagia and the highest icterus (30%) was found in serjoe serogroup. In this study, serjoe serogroup with fever and icterus, and then icterohemorrhagia with fever and gastrointestinal symptoms were introduced as the most common serogroups of Leptospirosis. Also the rarest serogroups were canicola and pomona.

BACKGROUND & PROPOSE: Brucellosis is serious disease around the world, especially in underdeveloped countries. It’s clinical manifestations is extensive. Thus diagnosis and treatment of this infection have difficulties, in among them, relapse is a great problem. This study aimed to evaluate risk factors of relapse after treatment in patients.METHODS: It is a descriptive-analytic study from 1990 to 2014, in Ayatolla Rohani hospital in Babol, Iran. We studied 980 patients with brucellosis. The studied community included patients infected with brucellosis and the required information was gathered based on their hospital files. The base for recognizing Malta fever were clinical symptoms and Para-clinical sign congruent with infection like as, titer SAT>1:320 and 2-ME>1:160. Patients with relapse and patients without relapse were placed separately in two groups. The data were statistically compared with Spss 16, by Chi-square and Cox –regression tests.RESULTS: Based on this study, treatment regimen is a preventive factor (P=0.000). Moreover, Based on some statistical methods, regimens no. 3 and 4 were introduce preventive factors (P=0.001) and (P=0.004). It should also be noted that findings the same statistical model, factors like gender, age, residence, professional contacts, complications and delay in treatment were also analyzed but none of them are considered as preventive factors.CONCLUSION: Since the main and exact reason for Malta fever’ relapse is not recognized yet, anticipation of relapse is beneficent for treatment of infection.