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Background: 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 on the frequency of drug-resistant bacteria in an ICU. Materials and Methods: 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 of antibiotic 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. Results: 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). Conclusion: 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. [ABSTRACT FROM AUTHOR]

Purpose: 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. Materials and Methods: 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. Results: 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). Conclusion: 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. [ABSTRACT FROM AUTHOR]

Background: Colistin is a common antibiotic used to treat urinary tract infections (UTIs) caused by gramnegative 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. Materials and Methods: In this randomized, open-label, parallel groups controlled trial, 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 disease specialist evaluated the therapeutic responses 48-72 hours after admission. Cessation of fever, improvement of symptoms and signs, and negative urine culture within 48 hours were considered successful therapeutic responses. Results: 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). Conclusion: 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). [ABSTRACT FROM AUTHOR]

Background: 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. Materials and Methods: 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. Results: 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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Background: Multiple risk factors are supposed to progress oral cavity carcinoma and among them, the role of neither bacterial nor viral infections should be underestimated. Despite relentless efforts, the accelerating effects of human papillomavirus (HPV), Epstein-Barr virus (EBV), and Porphyromonas gingivalis (P. gingivalis) on oral cancer has not yet been recognized successfully. Taking advantage of these facts, in this study we evaluated the prevalence of HPV, EBV, and P. gingivalis in oral cavity carcinoma. Materials and Methods: A total of 43 oral cavity cancerous tissues and 29 healthy oral ones were collected from Loghman Hospital, Tehran, Iran, between 2016 and 2018. After DNA extraction, the prevalence of HPV, EBV, and P. gingivalis was evaluated by PCR. Results: There were 53.5 well-differentiated (15 male, 9 female), 41.8% moderate (10 male, 5 female), and 4.7% poor (1 male, 3 female) adenocarcinoma paraffin-embedded tissue samples. PCR analysis has shown that there were 1 HPV (age: 46; moderate adenocarcinoma) and 1 EBV (age: 62; moderate adenocarcinoma) positive in different samples. No P. gingivalis was found and there was not any infected tissue with both EBV and HPV. In 31% of control tissues, blisters were observed and in 51.7% there was no mucus. We did not find any association between age, sex, and HPV, EBV positive samples. Conclusion: As sample size can affect the results of epidemiological and clinical study, and due to the low number of positive samples in this study, we concluded that HPV, EBV, and P. gingivalis may not have a detrimental effect on the progression of oral cancer, but further studies are needed. [ABSTRACT FROM AUTHOR]

Background: 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. Materials and Methods: This study was conducted at the infectious disease ward of Shahid Labbafi Nejad Hospital (Tehran, Iran) from 3rd of April 2020 up until 3rd of 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. Results: 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 O2 saturation of patients with final outcome of death and discharged before plasma therapy were 67 (33%) and 77 (83%), respectively, an improvement, defining partial resolution of lesions of chest CT scan or stop in progression of infiltrations was detected in all of 6 discharged patients. Conclusion: Convalescent plasma may have effective role in improving O2 saturation, 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. [ABSTRACT FROM AUTHOR]

Background: Pseudomonas aeruginosa is one the most important nosocomial pathogens, especially in immunocompromised patients. Identifying the source of contamination in health centers plays an important role in the control of hospital infections. The aim of this study was to determine antibiotic susceptibility and genetic patterns of P. aeruginosa isolated from patients hospitalized in intensive care unit of Masih Daneshvari Hospital, Tehran, Iran. Materials and Methods: Antibiotic susceptibility of the isolates was examined through 10 antibiotics recommended by Clinical and Laboratory Standards Institute (CLSI, 2018) guidelines using the Kirby-Bauer disc diffusion method. Random amplified polymorphic DNA (RAPD) analysis with the short primer of 272 was used to evaluate genetic relationship among the isolates and the results were analyzed by Gelcompar II software. Results: Of the antibiotics used, the most sensitive was found in colistin (96.4%) and the highest resistance rates were observed in cefotaxime (94.6%), chloramphenicol (83.9%) and imipenem (71.4%). DNA fingerprinting was able to identify 12 genetic patterns by RAPD-PCR technique. Conclusion: Antibiotic resistance in isolates of P. aeruginosa is rising and there is possibility of occurring outbreaks in the medical centers. Different sources of strains show their constant exchange via intra- and extrahospital transmission routes. Thus, according to the data of this study, there is a serious need to control sources of infections by physicians and staff when they are working in several sectors to control and prevent the transmission of the bacterium. [ABSTRACT FROM AUTHOR]

Background and Aim: During the past few years, social networking has become very popular. Currently, there is a lack of information about the uses, benefits, and limitations of social media for health communication in society. Material and Methods: This paper will review some of challenges and opportunities to use social and their impact on psychological health. In this review we searched all valuable and relevant information considering the social media impact on psychological health. We referred to the information databases of Medline, PubMed, Scopus and Google scholar. Conclusion: Social media brings a new dimension to health care, offering a platform used by the public, patients, and health professionals to communicate about health issues with the possibility of potentially improving health outcomes. More study is required to establish whether social media has impact on mental health in both the short and long terms. [ABSTRACT FROM AUTHOR]

Background and Objectives: 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. Materials and Methods: 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. Results: 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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Background and Objectives: Different studies show that the prevalence of hepatitis viruses in hemodialysis (HD) patients is much greater than general population. It is important to be aware of local prevalence data, in order to control infections and prevention of nosocomial transmission. The aim of this cross-sectional study was to investigate the seroprevalence of hepatitis B, C, and D viral infections among HD patients. Materials and Methods: During 2016, a cross-sectional study was conducted in Tehran, among 360 HD patients from 5 hemodialysis centers. All HBsAg positive subjects were screened for Hepatitis B surface Ag (HBsAg), Hepatitis C virus Ab (HCVAb) and Hepatitis D virus antibody (HDVAb), using specific enzyme linked immunoassay. Results: 360 patients were involved including 213 males (59.17%) and 147 females (40.83%). The mean age in current study was 53.43 years. HBV positive (HBsAg positive) was found in 1.39% of patients, HCVAb in 3.06%, whereas no HDV positive patient was diagnosed. In HD, duration of 1-5 years has the highest frequency rate. Conclusion: Prevalence of HBV, HCV and HDV in hemodialysis patients seems low in Tehran province. Due to higher prevalence of HCV, it is recommended to check the patients for anti-HCV Ab before admission to the centers. [ABSTRACT FROM AUTHOR]

Background: Nosocomial infections are one of the health problems of modern societies, which are rising with unusual organisms. Acintobacter, which is the main cause of nosocomial infections such as pneumonia and nosocomial pneumonia, is caused by mechanical ventilation. Acinetobacter species are becoming resistant to antibiotics. One the most important agent of nosocomial infections with high mortality is infections by Acinetobacter baumannii which is Gram- negative opportunistic Coccobacilli. Treatment in these infections is difficult and sometimes impossible, due to multidrug resistance in strains isolated from nosocomial infections. Objectives: The aim of the current study was to evaluate antibiotic resistance in A. baumannii isolates Khatam-Al-Anbia Hospital, Tehran, Iran. Methods: In this cross-sectional study 100 of Acintobacter baumannii were isolated from hospitalized patients during 2013-2015 in Khatam-Al-Anbia hospital in Tehran. In this study samples of A. baumannii isolated from trachea, blood, urine, sputum and wound samples of patients bedridden in Intensive care unit (ICU) wards. Antimicrobial susceptibility and minimum inhibitory concentration (MIC) were determined by E-test methods. We used descriptive statistics to analyze the data by using SPSS 21 software. Results: A total of 100 A. baumannii were isolated from clinical samples. The organism was resistant to rifampicin (46%), gentamicin (67%), meropenem (100%), piperacilin (98%), colistin (0%), and ceftazidin (96%). Conclusions: The antibiotic resistance against most of the antibiotics especially meropenem is very high in this study. Moreover, colistin was most effective antibiotic to be used in A. baumannii infections. Colistin is the best choices for treatment of Acinetobacter. [ABSTRACT FROM AUTHOR]

Middle East respiratory syndrome coronavirus (MERS-CoV) Infection, has caused recurrent outbreaks worldwide. It is associated with severe morbidity and mortality, and is not treatable with the currently available antiviral therapies. We present a case of a 43 year-old male healthcare provider, who admitted with productive cough, dyspnea, myalgia, pleuritic chest pain and fever. Computed tomography (CT) showed bilateral ground glass opacities and consolidation. Sputum polymerase chain reaction (PCR) for MERS-coronavirus was positive. [ABSTRACT FROM AUTHOR]

Background: Nowadays, nosocomial infection with multidrug-resistant Acinetobacter is an important problem in the world, which is facing wide spectrum antibiotics and hence has become resistant. Materials and Methods: In this study, positive cultures of Acinetobacter from one hundred clinical samples in seven hospitals from Tehran during 2012-2013 were collected for checking antibiotic susceptibility. Samples test with Ceftazidim, Cefepime, Amikacine and Imipenem by E-test and for Tazocin, Colistin and Tigecycline was performed with disk diffusion method. Results: For Colistin 10 samples, and for Tazocin, 40 samples were performed by E-test method. Then boumannii species of bacteria and non-baumannii Acinetobacter were separated by PCR and antibiotic susceptibility testing was performed on them. 89% of Acinetobacter samples were boumannii species, which was isolated from respiratory secretions at ICU. Conclusion: Boumannii and non-boumannii species of bacteria with a high percentage were resistant to Ceftazidim, Amikacine, Cefepime, Tazocin and Imipenem. All baumannii and non-boumannii Acinetobacter were sensitive to Colistin, were only 75% sensitive to Tigecycline, which is a new glycylcycline. Colistin and Tazocin results in samples limited to the E-test method were similar with disk diffusion. [ABSTRACT FROM AUTHOR]

Background: Helicobacter pylori multiplies and causes infection in human gastric mucosal layer. New approaches have focused on using specific treatments, such as immunotherapy, to limit this infection. Urease, as one of the most important virulent and antigenic factors of the bacterium, is a suitable target for this purpose. Patients and methods: In order to prepare recombinant proteins, the synthetic genes for total ureC protein (UreCt) and its N (ureCn) and C (ureCc) terminal fragments were ligated into pET28a. The recombinant proteins were expressed in E. coli BL21(DE3). White leghorn hens were injected with the purified recombinant proteins. IgY recovered from egg yolk, using PEG precipitation. Finally, urease neutralizing ability of the antibodies was evaluated by urease activity assay in presence of the purified IgY. Results: SDS-PAGE analysis revealed a good expression and purification of the recombinant proteins. Indirect ELISA observation demonstrated high antibody titer in sera and egg yolks and high ability of IgY Anti-UreCt and IgY Anti- UreCc antibodies in recognition of urease subunit C. Anti-UreCT and Anti-UreCc IgYs were more potential H.pylori urease inhibitors than Anti-UreCn. Conclusion: While all three UreC fragments induce prophylactic responses. UreCt and UreCc possess almost equal responses. Anti-UreCc IgY has advantage of smaller size and is preferred for its activity and easier protein recovery and purification process. These features emphasize on importance of simpler, easier and cost effective antibody production. [ABSTRACT FROM AUTHOR]

Abdominal tuberculosis is one of the most prevalent forms of extra-pulmonary tuberculosis. Various regions of gastrointestinal tract including cecum, terminal ileum, peritoneum, lymphatic system, and solid viscera can be affected by tuberculosis. Here we report a 33-year-old woman presented with fever, chills, and a history of abdominal discomfort. Lymphadenopathy was detected on physical examination. Contrast computed tomography of chest and abdomen showed patchy densities and thickening of the ileocecal wall respectively. Histological studies of the biopsy samples documented the existence of tuberculosis. [ABSTRACT FROM AUTHOR]

Background: Cytomegalovirus (CMV) pneumonia is one of the most important infections in immunocompromised host. Immunosuppressive therapy plays a major role in reactivation of CMV. Patient: The patient was a 56-year old lady, known case of chronic lymphocytic leukemia (CLL), had been taking prednisolone and chlorambucil, who presented with dyspnea and productive cough. After bronchoalveolar lavage (BAL), transbronchial lung biopsy (TBLB) and CT-guided biopsy, CMV pneumonia was diagnosed. Conclusion: CMV should be suspected as a cause of pneumonia in immunocompromised patient and diagnosis may require invasive procedures. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article published in the previous issue related with occupation exposure to blood-borne viruses.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) can cause serious infections not only in hospitals but also in the community. The present study was aimed to characterize drug resistance and virulence determinants of community-associated (CA) MRSA isolate compared with healthcare-associated (HA) MRSA., Materials and Methods: A total of 44 patients with HA-MRSA and 11 patients with CA-MRSA infection (median age, 72 years) were included. The clinical isolates of MRSA were subjected to molecular analysis of virulence genes and drug susceptibility testing., Results: Panton-Valentine leucocidin (PVL) exotoxin and toxic shock syndrome toxin (TSST) genes were disproportionately distributed between CA- and HA-isolates. PVL genes were more likely to be found among CA-isolates (36.4%) than HA-isolates (18.2). TSST genes were identified in only 2 CA-MRSA isolates tested (18.2%) compared with 9 HA-isolates (20.5%). Exfoliative toxin- b gene was negative in all isolates, however, one HA-isolate was positive for exfoliative toxin-a. mec-A gene was present in all clinical isolates. CA-isolates were more likely to be susceptible to trimethoprim-sulfamethoxazole and vancomycin compared with HA-isolates. Vancomycin-intermediate resistance was found in 2 HA-isolates. All clinical isolates were also resistant to clindamycin., Conclusion: CA- and HA- MRSA isolates are epidemiologically and microbiologically distinct. Thus, the strategies to prevent and treat these infections would be different. Patients with CA- and HA-MRSA infections should be treated effectively and receive follow-up evaluation to ensure the resolution of their infection. Surveillance studies should be conducted to determine the extent of CA- and HA-MRSA dissemination in Iran., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Introduction: Febrile neutropenic patients are at risk of serious infections. The aim of the present study is to identify the frequency, species, and susceptibility patterns of candidemia in febrile neutropenic patients., Methods: This cross-sectional study was conducted on febrile neutropenic patients suspected with candidemia who had been referred to 3 educational hospitals during 9 months., Results: The blood samples of 80 febrile neutropenic patients with the mean age of 48±16.6 years were studied (60% female). Five (6.25%) episodes of candidemia were identified. The underlying disease was acute myeloid leukemia in 4 (80%) cases and all 5(100%) cases had central venous catheter and were receiving prophylactic ciprofloxacin and acyclovir. 100% of isolates were found to be susceptible to Voriconazole, 80% to Caspofungin, 60% to Amphotericin B, and 40% to Fluconazole., Conclusion: The frequency of candidemia among the studied febrile neutropenia patients was 6.25%, with 80% mortality rate, and the most frequently identified yeast was Candida albicans (100% susceptible to Voriconazole)., Competing Interests: The authors declare that they have no conflicts of interest.