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Considering the outbreak pandemic of Coronavirus Disease 2019 (COVID-19), the lack of effective therapeutic strategies for the management of this viral disease, and the increasing evidence on the antiviral potential of silymarin, this study aimed to investigate the effectiveness of silymarin nanomicelles on the symptom's resolution time, laboratory parameters, and liver enzymes in patients with COVID-19. The participants were assigned to the nano-silymarin (n = 25) (receiving SinaLive soft gel, containing 70 mg silymarin as nanomicelles) or placebo groups (n = 25) three times daily for two weeks. Patients' symptoms and laboratory findings were assessed at baseline and during the follow-up period (one week and one month after the beginning of the treatment). No significant differences were observed between the two groups in terms of symptoms resolution time, laboratory parameters, and hospitalization duration (p 0.05). However, the alanine aminotransferase level decreased significantly in the treatment group, compared to the placebo group (p 0.001). Concomitant use of dexamethasone and remdesivir with silymarin might make the effects of silymarin on the improvement of patients' condition unclear. Further clinical trials are recommended with diverse dosages and larger sample sizes.

Background: Influenza is a contagious and acute viral disease caused by influenza viruses involving upper and lower respiratory tract system, especially in the cold seasons. Children aged less than 5 years old, elderly people, immunocompromised patients, pregnant women, and people with certain health conditions are at a higher risk for the disease and severe complications. Objectives: Due to the serious complications of influenza in certain groups, it is important to know which group of people are more at risk and need prevention strategies. This study aimed to investigate the patients with confirmed influenza, identify the people who are at a higher risk for infection, and assess the clinical outcomes of disease among patients. Methods: In this cross-sectional and descriptive study, we studied the files of all patients with confirmed influenza referred to the health centers in Mashhad, Iran, during autumn and winter of 2019 when influenza virus was prevalent. The disease was confirmed by reverse transcription polymerase chain reaction (RT-PCR) method. We studied all registered data related to the flu, including gender, age, residency, history of vaccination, risk factors, complications, and clinical outcomes. Results: In this study, 2977 patients (3% outpatients vs. 97% hospitalized) with flu like syndrome were tested by RT-PCR for influenza. Out of 84 outpatients, only two cases were positive for influenza. Among hospitalized patients, 80 cases (51% male vs. 49% female; age range: 1 - 87 years) had a positive RT-PCR test, and influenza type A was seen in 95% of cases. Pneumonia was the most common complication. Death happened in 29 (35.36%) patients and three (33.33%) cases with risk factors. The highest number of influenza patients (31 [37.8%]) had been reported from district No. 3 of Mashhad municipality, which is a crowded place and near the holy shrine. Conclusions: The results showed a high prevalence of complication and death among hospitalized patients, especially among those who did not have a risk factor for influenza viruses. Comprehensive vaccination programs and promotion of knowledge about transmission routes are two important measures for disease prevention and lower death rates.

Background: There is no pharmacological intervention on the treatment of hypoxemia and respiratory distress in COVID-19 patients. Objective: The objective of the study was to study the effect of the reduced form of methylene blue (MB) on the improvement of oxygen saturation (SpO2) and respiratory rate (RR). Methods: In an academic medical center, 80 hospitalized patients with severe COVID-19 were randomly assigned to receive either oral MB along with standard of care (SOC) (MB group, n = 40) or SOC only (SOC group, n=40). The primary outcomes were SpO2 and RR on the 3rd and 5th days. The secondary outcomes were hospital stay and mortality within 28 days. Results: In the MB group, a significant improvement in SpO2 and RR was observed on the 3rd day (for both, p < 0.0001) and also the 5th day (for both, p < 0.0001). In the SOC group, there was no significant improvement in SpO2 (p = 0.24) and RR (p = 0.20) on the 3rd day, although there was a significant improvement of SpO2 (p = 0.002) and RR (p = 0.01) on the 5th day. In the MB group in comparison to the SOC group, the rate ratio of increased SpO2 was 13.5 and 2.1 times on the 3rd and 5th days, respectively. In the MB group compared with the SOC group, the rate ratio of RR improvement was 10.1 and 3.7 times on the 3rd and 5th days, respectively. The hospital stay was significantly shortened in the MB group (p = 0.004), and the mortality was 12.5% and 22.5% in the MB and SOC groups, respectively. Conclusions: The addition of MB to the treatment protocols significantly improved SpO2 and respiratory distress in COVID-19 patients, which resulted in decreased hospital stay and mortality. ClinicalTrials.gov: NCT04370288.

BACKGROUND: Drug resistance is a leading concern in control of TB. Resistance against rifampin as one of the most important drugs in the treatment of Mycobacterium tuberculosis is caused by mutations in the 81-base pair region of the rpoB gene encoding the β-subunit of RNA polymerase. This study aimed to characterize the mutations in the rpoB gene associated with rifampin resistance among M. tuberculosis.METHODS: This study was conducted on referred samples of patients who did not respond to anti-TB treatment, in Tuberculosis Regional Reference Laboratory at Shariati Hospital. Drug susceptibility of M. tuberculosis isolates was surveyed using a proportional method on LJ medium. The isolates with resistant to rifampin were reconfirmed and then the rpoB gene was amplified and sequenced.RESULTS: Among 27 resistant cases, 8, 11 and 8 people were from Iran, Afghanistan, and Turkmenistan, respectively. In 26 out of 27 isolates, rpoB gene mutations were observed. The most prevalent mutations belonged to the codon 53. The most prevalent mutations belonged to the TCG (Ser) 531TTG (leu) with prevalence 51.8% (n=14), and GAC (Asp)516TAC (Tyr), CAC (His) 526GAC (Asp) and CAC (His) 526TAC(Tyr) mutations with prevalence 14.8%(n=4). Twenty-three isolates had just one mutation.CONCLUSION: The use of rpoB gene sequencing led to the lack of the need for growth of the organism in the culture medium, the direct use of clinical samples, reduction of biological risks and a detection about 96.3% of MDR TB cases lowering the cost of the treatment.KEYWORDS: Drug-resistant, Mycobacterium tuberculosis, rpoB gene, Rifampicin

BACKGROUND: Drug resistance is a leading concern in controlof TB. Resistance against rifampin as one of the most importantdrugs in the treatment of Mycobacterium tuberculosis is causedby mutations in the 81-base pair region of the rpoB gene encodingthe β-subunit of RNA polymerase. This study aimed to characterizethe mutations in the rpoB gene associated with rifampin resistanceamong M. tuberculosis.METHODS: This study was conducted on referred samples ofpatients who did not respond to anti-TB treatment, in TuberculosisRegional Reference Laboratory at Shariati Hospital. Drugsusceptibility of M. tuberculosis isolates was surveyed using aproportional method on LJ medium. The isolates with resistant torifampin were reconfirmed and then the rpoB gene was amplifiedand sequenced.RESULTS: Among 27 resistant cases, 8, 11 and 8 people were fromIran, Afghanistan, and Turkmenistan, respectively. In 26 out of 27isolates, rpoB gene mutations were observed. The most prevalentmutations belonged to the codon 53. The most prevalentmutations belonged to the TCG (Ser) 531TTG (leu) withprevalence 51.8% (n=14), and GAC (Asp)516TAC (Tyr), CAC(His) 526GAC (Asp) and CAC (His) 526TAC(Tyr) mutationswith prevalence 14.8%(n=4). Twenty-three isolates had just onemutation.CONCLUSION: The use of rpoB gene sequencing led to the lackof the need for growth of the organism in the culture medium, thedirect use of clinical samples, reduction of biological risks and adetection about 96.3% of MDR TB cases lowering the cost of thetreatment.

Background: The emergence of Penicillin resistance and multidrug-resistant pneumococcal strains is a global concern. Several reports have demonstrated a correlation between increased Minimal Inhibitory Concentration (MIC) of Penicillin, and increased MICs of Cephalosporins and other β-lactam antibiotics. It should be pointed out that pneumococcal resistance to Penicillin may predict an unfavorable response to other β-lactam antibiotics. Objectives: To outline pneumococcal resistance to Ceftriaxone, a microbiological survey was performed on pneumococcal strains, during a two-year period. Patients and Methods: In this study, 35 strains of Pneumococci were isolated from blood samples of 35 different consecutive patients, admitted to two educational hospitals in Mashhad, North East of Iran during a two-year period of this prospective study, the minimal inhibitory concentration (MIC) of Ceftriaxone was determined, using E-test. Results: Amongst 35 clinical isolates, evaluated in this study, only one isolate (2.86%) was resistant to Ceftriaxone (MIC > 1) and 34 isolates (97.14%) appeared to be sensitive to this antibiotic. MIC ranged from 0.012 to 6 and MIC50 and MIC90 were 0.07 and 0.5, respectively. Conclusions: Considering the low rate of Ceftriaxone resistance amongst isolated pneumcocci.in this study, Only Ceftriaxone treatment of adult patients with invasive pneumococcal infections (other than CNS infections) is sufficient; but pediatric patients and patients with CNS infections should be treated with Ceftriaxone and Vancomycin. Apparently, diminution of Vancomycin use can be resulted in reduction of the resistance rate among other bacteria, sensitive to this antimicrobial agent, such as Methicillin-resistant Staphylococcus aureus and Enterococci.

Introduction. Tuberculosis is still one of the most important health problems in developing countries and increasing drug resistance is the main concern for its treatment. This study was designed to characterize the drug resistantMycobacterium tuberculosisisolated from patients suffering from pulmonary tuberculosis in northeast of Iran.Method. In this cross-sectional study during 2012-2013, drug susceptibility testing was performed onMycobacterium tuberculosisisolated in northeast of Iran using proportional method. Epidemiological data concerning these strains were also analyzed.Results. Among 125 studied isolates, 25 mycobacteria (20%) were diagnosed as nontuberculosis mycobacteria. Among the remaining 100Mycobacterium tuberculosisisolates, the resistance rates were 7%, 7%, 3%, and 9% against isoniazid, rifampin, ethambutol, and streptomycin, respectively. Four isolates were resistant against both isoniazid and rifampin (MDR tuberculosis). The highest resistance rate was observed among 15–45-year-old patients. The MDR tuberculosis was much more prevalent among those who had previous history of treatment.Conclusion. Considering these findings, DOTS strategy should be emphasized and promptly used in order to prevent further resistance. Regarding the high rate of nontuberculosis mycobacteria, it is recommended that confirmatory tests were performed before any therapeutic decision.