alireza abdollahi

Bacterial infection among neonatal patients admitted to the neonatal intensive care unit (NICU) is a global crisis and is among the first causes of neonatal mortality globally. Hence, this study aimed to evaluate the prevalence of bacterial pathogens from collected samples of neonatal infection in the NICU of a tertiary care center in Tehran, Iran.
In this study, we used data from blood, ulcer/fluids, and urine samples of NICU neonates at Imam Khomeini Hospital from 2019 to 2022.
Overall, 712 urine cultures (144 positives), 4578 blood cultures (376 positives), and 1771 ulcer/fluid cultures (411 positives) were gathered. Among positive blood cultures, the most prevalent bacterial species was Klebsiella pneumonia (120, 32.88%). Among urine cultures, the most prevalent bacterial species was Klebsiella pneumonia (71, 49.31%). Among positive ulcer/fluid cultures, the most prevalent bacterial species were Coagulase Negative Staphylococci (150, 36.49%). The highest sensitivity of Klebsiella pneumonia was against Ciprofloxacin (15.83%) in blood samples and resistant to Gentamycin (81.67%). Among urine samples, the highest sensitivity of Klebsiella pneumonia was against Ciprofloxacin (29.58%%) and the highest resistance against Gentamycin (84.51%). Among the ulcer/fluid samples, the highest sensitivity of Coagulase Negative Staphylococci was against Ciprofloxacin (13.48%) and the highest resistance against Cotrimoxazole (14.81%).
The most prevalent bacterial species found were Klebsiella pneumonia and Coagulase Negative Staphylococci. These species showed high resistance against multi drugs such as Cotrimoxazole, Ampicillin-sulbactam, and Piperacillin-tazobactam. National health policymakers should focus on surveillance programs to control and monitor such trends in antibiotic resistance.

Cerebral ischemia/reperfusion (I/R) injury is the most prevalent form of brain stroke, affecting many patients worldwide. It is believed that oxidative stress and inflammation play major roles in the damage that occurs after the initiation of the disease.

Therefore, for the first time, the current study aimed to investigate the neuroprotective effects of bupropion against cerebral I/R damage in a rat model.

Forty male rats were divided into four groups: Control, cerebral I/R, and two diseased groups that received 60 and 100 mg/kg of bupropion. One day after induction of the disease, behavioral tests, including grid walking, novel object recognition, and modified neurological severity score (mNSS), were performed on the rats. The levels of inflammatory cytokines, including IL-1β, TNF-α, IL-6, and IL-10, were measured in the rats' brain homogenates. Additionally, the levels of MDA, catalase (CAT), superoxide dismutase (SOD), reduced glutathione (GSH), and NO2 - were measured.

Bupropion administration was associated with improved performance in the novel object recognition and grid walking behavioral tests, as well as in the neurological disorder scores, in cerebral I/R rats. Moreover, BCAAO-induced inflammation was reduced by the administration of this drug, evidenced by reduced levels of cytokines IL-1β, TNF-α, and IL-6 and upregulation of IL-10. Additionally, membrane lipid peroxidation was reduced in the cerebral I/R rats receiving 100 mg/kg bupropion, and the level of SOD activity was improved in these animals. Finally, the administration of bupropion prevented the increase in NO2 - levels induced by BCAAO.

In conclusion, bupropion has neuroprotective effects against cerebral I/R damage by reducing inflammation and oxidative stress in the brain.

Rhizopus arrhizus, a major contributor to COVID-19-associated mucormycosis (CAM) globally. Nanoliposomal amphotericin B (NLAmB) presents a promising approach due to its enhanced drug delivery and reduced side effects. This study aimed to assess the in vitro antifungal susceptibility of NLAmB against R. arrhizus isolated from CAM patients.

Thirty-nine R. arrhizus isolated from CAM patients were identified through phenotypic characterization, MALDI-TOF, and the internal transcribed spacer rDNA region (ITS) sequencing approaches. Antifungal susceptibility testing (AFST) for NLAmB, amphotericin B (AmB), posaconazole (PSC), and isavuconazole (ISC) was conducted through broth microdilution methods according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) standard E.DEF 9.4. Results were analyzed for MIC ranges, MIC50, MIC90, and distributions.

NLAmB demonstrated superior in vitro efficacy against R. arrhizus (MIC50/90, 0.063/0.25 μg/ml) compared to AmB, PSC, and ISC. PSC exhibited notable activity (MIC range: ≤0.031 - ≥16 μg/ml).

The study emphasized NLAmB's sustained activity, making it a potential alternative to LAmB. Further exploration and clinical correlation are warranted to validate NLAmB in CAM treatment.

It is proved that if $sum_{gin G} a_g g$ is a non-zero zero divisor element of the complex group  algebra $mathbb{C}G$ of a torsion-free group G then  $2sum_{gin G} |a_g|^2<big( sum_{gin G} |a_g|big)^2$.

The coronavirus disease brought worldwide uncertainty, and Iran was affected by it as well as many other countries in the world. Halting face-to-face education due to social distancing and resident re-employment in clinical wards leads to defective education. The aim of this survey was to evaluate the advantages and disadvantages of modifications made in pathology residency education in Iran.

This online survey was conducted on all pathology residents in Iran. An online 30-item questionnaire was developed and used in this study.

Sixty residents (88.3% female) participated in this survey. The majority (70%) of the residents were over 30 years old. Fifty percent of the responders reported that their personal life was influenced by the pandemic. Skyroom and Adobe Connect were the most common platforms for online education with overall satisfaction of 65%. The webinars were considered suitable by 51.7% of the responders. Concerns at work were reported by 48.3% of the residents, while 78.3% reported being exposed to the disease and 55% reported being infected. Concerns about transmission of the disease to family members were reported by 90% of the responders.

This study showed that the pathology residency modifications were successful in providing education. However, their social and educational life characteristics might affect their satisfaction with online education.

Cerebrospinal fluid (CSF) analysis is helpful in the diagnosis of infections of the central nervous system (CNS), especially after neurosurgical procedures. This study aimed to evaluate the diagnostic value of CSF markers for diagnosis of post-neurosurgical meningitis (PNM).

Patients with neurosurgical procedures whose CSF was obtained for any reason (meningitis and non-meningitis) during 2020 and 2022, at Imam Khomeini Hospital Complex, Tehran, Iran, were included. Serum and CSF lactate dehydrogenase (LDH), glucose, protein, white blood cells (WBC), red blood cells (RBC), and CSF/serum glucose and LDH ratio were compared between the patients who were diagnosed with PNM and those without meningitis.

A total of 115 patients were included, of whom 23 patients were diagnosed with PNM and 92 with non-meningitis. No significant differences were observed in patients’ age, gender, and underlying diseases between the two groups. Findings showed a significantly (P=0.029) lower level of the mean CSF glucose (59.5 mg/dL ±33.9) in patients with meningitis than in patients without meningitis (76.8 mg/dL ± 37.5). The mean CSF/serum glucose ratio was 43.7% in the meningitis group and 56.3% in the non-meningitis group (P=0.008). The mean WBC count and neutrophil dominance were significantly higher in the meningitis group. No significant differences were observed in CSF LDH, Protein, and RBC between the two groups.

A CSF glucose level of less than 60 mg/dL, a CSF/serum glucose ratio of less than 0.44, and a higher CSF WBC and neutrophil count can help diagnose PNM.

Coexisting pulmonary aspergillosis and tuberculosis in a post-COVID-19 patient is rare. Here, we are going to report a case of combined pulmonary aspergillosis and tuberculosis in a 51-year-old female who was previously diagnosed with COVID-19 pneumonia. The patient was treated with voriconazole and anti-tuberculosis agents.

There has been a rise in COVID-19-associated mucormycosis (CAM) cases, particularly in low-income countries. We describe a case of primary cutaneous mucormycosis after recovering from COVID-19 in a kidney transplant recipient who had a known case of diabetes mellitus. The patient developed cutaneous ulcers due to Rhizopus oryzae in the right hand. She did not recall any trauma or injury at the affected site. Based on the appearance of the wound we suspected that healthcare-associated mucormycosis could be the causative agent. Due to the initial misdiagnosis as a bacterial infection, the appropriate treatment was delayed, and the lesions progressed rapidly to necrotic ulcers with jagged margins that deteriorated during hospitalization. She underwent consecutive surgical interventions and received broad-spectrum antifungal therapy. Finally, the patient deceased after 32 days of hospital stay. We reviewed the previous case reports of cutaneous mucormycosis occurring in COVID-19 patients and described patient characteristics, predisposing factors, location of ulcers, clinical presentation, management, and outcome. This report and existing published literature indicate a poor outcome for cutaneous mucormycosis in COVID-19 patients and the importance of early diagnosis, aggressive multidisciplinary management, and regular follow-up as a life-saving measure, especially in immunocompromised patients.

Fungal co-infections increase the incidence and mortality of viral respiratory tract infections. This study systematically reviews and conducts a meta-analysis to evaluate the prevalence of COVID-19 patients with fungal coinfections. The aim is to provide a concise overview of the impact of these infections on patient outcomes especially association with risk of mortality, informing future research and optimizing patient management strategies.

To identify relevant studies on COVID-19 patients, we conducted a systematic search of databases from the beginning of the year until July 2023, including fungal co-infections, mortality, and sequelae. Eligibility criteria were developed using the PICO framework, and data extraction was carried out separately by two authors using standard techniques. Statistical analysis was performed using the correlation model and differences between studies were evaluated using the I2 test. R and RStudio were used for statistical analysis and visualization.

We initially identified 6,764 studies, and after checking for equivalence and consistency, 41 studies were included in the final analysis. The overall COVID-19 odds ratio for people who died from fungal infections was 2.65, indicating that patients infected with both COVID-19 and fungal infections had a higher risk of death compared to patients with COVID-19 alone. Specifically, COVID-19-associated pulmonary aspergillosis (CAPA) has a higher odds ratio of 3.36, while COVID-19-associated candidiasis (CAC) has an odds ratio of 1.84, and both are much more associated with death. However, coinfection of the fungus with other fungal species did not show a significant difference in the risk of mortality.

This study identified CAPA and CAC as the most common infections acquired in healthcare settings. Fungal coinfections may be associated with an increased risk of death in COVID-19 patients.

Gastric cancer (GC) patients have a poor prognosis mainly due to late diagnosis. We aimed to study the prognostic effects of various biomarkers, including HER2, CD34, p53, Ki67, Cox2, MMP7, and vimentin in GC.

We performed immunohistochemistry (IHC) to examine the expression of potential biomarkers in 140 GC patients. CD34 protein expression was quantified to assess angiogenesis through scoring microvessel density (MVD). We used a multivariable Cox-proportional hazard model to estimate hazard ratios (HRs) representing the prognostic role of the biomarkers and the clinicopathological parameters.

Patients diagnosed at the advanced tumor stage exhibited a significantly higher risk of mortality than those diagnosed at the early stages (HR = 5.96, CI: 3.73 – 9.51). We also observed higher risks of mortality in patients with high MVD-CD34 (HR = 5.35, CI: 2.36 – 12.12), HER2-positive (HR = 2.82, CI: 1.69 – 4.37), p53-positive (HR = 4.03, CI: 2.53 – 6.4), high Ki67 (HR = 4.34, CI: 2.64 – 7.13), high Cox2 (HR = 4.77, CI: 2.39 – 9.49), high MMP7 (HR = 2.75, CI: 1.53 – 4.94), and high vimentin (HR = 3.78, CI: 1.7 – 8.39) tumors compared to their corresponding reference groups. The association was statistically significant for HER2, p53, Ki67, Cox2, and MVD-CD34 among those diagnosed in an early stage.

Overall, evaluation of tumor biomarkers in GC patients can result in more precise estimates of prognosis, especially in early-stage tumors. These biomarkers could potentially be considered for targeted therapy of GC patients to improve their survival.

 Sentinel lymph node biopsy (SLNB) with injection of radiopharmaceuticals is now the standard of care for staging the axilla in patients with breast cancer. Sulfur or antimony colloids labeled with 99mTechnetium (Tc) are used globally for the procedure, with a detection rate of 94%. However, in Iran, Tc phytate has been used because it is more easily producible in the country. The detection rate with Tc phytate has not been well determined in large-scale studies.

 We performed this study to report the detection rate of SLNB with Tc phytate, its advantages and disadvantages using large multicentric data.

 This is a retrospective cross-sectional multicenter study. Participants were breast cancer patients without previous history of axillary surgery, who underwent sentinel node biopsy using Tc phytate on the morning of surgery or the day before. The detection rate was calculated as the number of patients with histologically positive sentinel nodes to all patients with histologically positive lymph nodes; we compared those injected on the day of surgery and those injected on the day before.

 Overall, 2663 women aged 50.2±11.6 years were included. The detection rate was 91.8% (806 out of 878). The false negative rate was 8.2% overall, and statistically similar for injections on the day or the day before surgery (2.9 vs 2.1; P=0.32).

 Tc phytate has a good detection rate for breast radio-guided SLNB with similar result for injections on the surgery day or the day before it.

 The coronavirus disease 2019 (COVID-19) pandemic has been a global shock since its initial spread in 2019. Medically, patients with coronavirus disease, especially those with pneumonitis, face serious life-threatening risks and often require mechanical ventilation and intensive care. Ventilator-associated pneumonia (VAP) remains a significant concern for critical care providers. Recent reports have highlighted the susceptibility of patients with confirmed COVID-19 receiving mechanical ventilation to nosocomial pneumonia (NP).

 This study was a cross-sectional study conducted in the intensive care unit (ICU) at Imam Khomeini Hospital Complex (IKHC) in Tehran, Iran, within April 2020 to April 2021. The study focused on critically ill COVID-19 patients who required mechanical ventilation and met the criteria for VAP. Standard biochemical assays were used to identify pure colonies in patients’ sample cultures, and antimicrobial susceptibility tests were conducted to assess antimicrobial resistance profiles. The findings were analyzed statistically using SPSS software (version 23.0).

 Out of 93 endotracheal aspirate samples, 64 samples tested positive for bacteria. Among the 64 eligible patients with positive cultures, 42 (65.6%) and 22 (34.4%) patients were male and female, respectively, with a mean age of 60.56 ± 13.58 years. A total of 52 patients (81.25%) had underlying conditions, such as hypertension, diabetes, and kidney or heart diseases. According to the study results, the most common pathogens were extensively drug-resistant (XDR) Klebsiella pneumoniae (7%) and Acinetobacter baumannii (23%). Additionally, 80% of Klebsiella pneumoniae and 90% of Acinetobacter baumannii were observed to be multi-drug resistant (P < 0.05).

 The COVID-19 pandemic has posed significant risks to critically ill patients, often necessitating mechanical ventilation and intensive care. Furthermore, VAP remains a serious challenge in this context, with high rates of XDR K. pneumoniae and A. baumannii. Effective infection control measures and surveillance are critical to mitigating the risk of NP in these vulnerable patients.

Unnecessary pre-operative ordering of red blood cells (RBCs) in elective surgeries increases costs and waste of blood inventory. Maximum surgical blood order schedule (MSBOS) is a helpful strategy in the estimation of blood units needed for surgery and the prevention of overconsumption. In this study, an MSBOS for pediatric cardiac surgeries is designed.

In this cross-sectional study, we included all pediatric patients who underwent elective cardiac surgery in Children’s Medical Center in Tehran, Iran, from March 21, 2019, to September 22, 2019. Data consisted of the type of surgery and the number of blood units transfused and units cross-matched, based on which cross-match to transfusion ratio (CTR), the transfusion index (TI), and transfusion probability (T%) were calculated.

Overall 205 pediatric patients were included in the study. Four hundred and ten RBCs units were cross-matched, and 262 were transfused. The overall results of the CTR, T%, and TI for all the eight types of cardiac surgery were 1.56 (410/262), 76% (157/205), and 1.28 (262/205), respectively. The raw MSBOS for cardiac surgeries included ventricular septal defect, tetralogy of fallot, dextro-transposition of the great arteries, atrial septal defect, aortic coarctation, patent ductus arteriosus, pulmonary stenosis, and pacemaker insertion, which were 1.58, 1.03, 1.54, 1.66, 0.77, 0, 1.25, and 0 unit, respectively, and the figures were rounded up.

Accurate MSBOS protocols reduce cross-match workload in laboratories, lead to the appropriate use of blood stocks with less wastage, save human and economic resources, and eventually, promote patient safety.

The most frequent type of cancer found in the endocrine system is thyroid carcinoma. Among well-differentiated thyroid malignancies, the most commonly occurring type is identified as papillary thyroid carcinoma (PTC), which makes up 70-90% of the cases. A subtype of PTC is papillary thyroid microcarcinoma (PTMC), which includes tumors smaller than 10 mm in diameter. Due to the advancements in diagnostic techniques, the incidence of this type of cancer is on the rise. In this study, we aimed to analyze the factors worsening the PTMC prognosis.

In the first step, we searched various databases for the factors affecting this tumor. The relevant articles were collected and different outcomes of this tumor and its associated factors which were studied in more than one article, were classified. Finally, we conducted a meta-analysis of these outcomes and their related factors.

In the meta-analysis, a significantly association was found between the following factors: recurrence with gender (P<0.001) lymph node metastasis (LNM) (P= 0.003), and extrathyroidal invasion (P<0.001); lymph node metastasis with extrathyroidal invasion (P<0.001), and multifocality (P<0.001); central lymph node metastasis (CLNM) with gender (P=0.001), tumor size (P<0.001), extracapsular invasion (P<0.001), lateral cervical lymph node metastasis (P<0.001), and extrathyroidal invasion (P<0.001); lymph node metastasis resulted in poor outcomes (P<0.001); and finally tumor size with BRAFV600E mutation (P<0.001).

In conclusion, it is essential to note that greater awareness and understanding of this tumor characteristics and special and separate attention to PTMC can significantly improve the society overall health.

Human epidermal growth receptor-2 (HER2) gene amplification is an important predictive and prognostic factor in breast cancer treatment. However, the expression of HER2 determined by immunohistochemistry (IHC) is considered as borderline in some cases, and confirmation of the HER2 status by either fluorescent in situ hybridization (FISH) or chromogenic in situ hybridization (CISH) is necessary for correct treatment decision-making. Considering the high cost of FISH and CISH, we aimed to investigate whether clinicopathological findings of the tumor could predict the HER2 status.  

A retrospective study was performed using the data from 584 patients with breast cancer with HER2-borderline disease, confirmed by IHC. Final HER2 status, pathologic tumor size and type, nodal involvement, Ki67 index, presence of estrogen and progesterone receptors (ER, PR), lymphovascular invasion (LVI), and stage were retrieved from the clinical records.

One hundred twenty-one (20.7%) patients were HER2-positive according to the FISH or CISH results. Logistic regression analysis showed that the pathologic size was positively associated with HER2 positivity with an odds ratio (OR) of 1.02 (95% CI: 1.01-1.04). In addition, the adjusted OR illustrated a statistically significant association between HER2 positivity and PR negativity (OR= 2.22, 95% CI: 1.29-3.83).

In HER2 borderline breast cancer, HER2 positivity significantly increases with tumor size and PR negativity. Further studies are recommended that may find an applicable model to predict the actual status of HER2 in borderline cases.

Antibiotic resistance, especially in the form of multidrug-resistant (MDR), is a big problem, especially in intensive care units (ICUs). This study aimed to evaluate antibiotic resistance and MDR patterns among patients hospitalized in the ICUs in one of the large referral centers in Iran.

The present study was conducted at Imam Khomeini Hospital in Tehran (a great referral hospital), which admits critically ill patients requiring ICU services. To determine the rate of positive cultures for resistant strains, the patient’s blood specimens were sent to the laboratory of the hospital for inoculation on proper culture media within 2 hours of extraction. Antimicrobial susceptibility tests were done using the Bauer–Kirby disk diffusion method.

A total of 1,755 samples were collected from the patients to assess microbial strains and antibiotic resistance. The most common microbial strains detected in the cultures extracted from peripheral blood samples were Klebsiella pneumonia (22.1%), Staphylococcus epidermidis (7.9%) and another coagulase-negative Staphylococcus (15.0%). The antibiogram test showed antibiotic resistance in 1,509 cases, leading to a resistance prevalence rate of 85.9%. The most common antimicrobial resistance observed was against cotrimoxazole (61.7%), ciprofloxacin (51.3%), imipenem (50.0%), and ampicillin (49.6%). The rate of MDR was found to be 96.3%.

In Iran’s ICUs, a significantly high level of antibiotic resistance may be seen especially the MDR pattern, which indicates the need to change the pattern of prescribing and managing these drugs in ICU centers.

Alloimmunization against blood group antigens is an important non-infectious complication of blood transfusion, and early detection of these alloantibodies by antibody screening before transfusion is crucial. Identifying which underlying factors will affect the occurrence of alloimmunization will be necessary to manage this event as accurately as possible. We aimed to assess the prevalence rate and main determinants of RBC alloimmunization among patients referred to a large referral blood bank in Iran.

This retrospective cross-sectional study was conducted on all patients referred to a blood bank at Imam Khomeini Hospital between October 2018 and September 2020. Information was collected by referring to the archives of the hospital information system as well as the documents recorded at the blood bank ward and reviewed by two pathologists and completed documents.

In total, 39 270 cases were cross-matched. Accordingly, the frequency of alloimmunization cases was equal to 220 cases, which indicated a prevalence of 0.56%. The most common alloantibodies were anti-K (43.2%, 95% CI: 36.8‒49.5), anti-E (34%, 95% CI: 27.7‒40.5), and anti-C (16.3%, 95% CI: 11.4‒21.4). Among patients with positive alloimmunization, the most common blood groups were blood group B (34.6%), followed by blood group A (34.1%). Most of these patients were Rh-positive (77.3%). In patients with positive alloimmunization, the frequency of hemoglobinopathy was estimated to be 37.7%. Frequent blood transfusions were found in 42.2%, a history of malignancy in 17.3%, graft history in 11.3%, and a history of pregnancy in 35.0%.

Alloimmunization was more prevalent and more predictable among patients with hemoglobinopathies and those receiving recurrent transfusions. Therefore, a history of repeated blood transfusions should be regarded as a risk factor contributing to alloimmunization.

 Patients undergoing orthopedic surgery are at risk of nosocomial infections, and antibiotic resistance is known to increase the risk of such infections.

 We aimed to determine the rate of antibiotic resistance in patients admitted to orthopedic wards in one of the largest referral hospitals in Iran. We also ascertained responsible antibiotic-resistant microorganisms in patients with bone and joint infections.

 The present cross-sectional investigation was concluded over a period of five years, from March 2018 to February 2023, at a great referral hospital in Tehran. Laboratory data, including the organisms isolated and their antibiotic resistance patterns, were collected by reviewing the hospital information system.

 In total, 2650 specimens obtained from patients with suspected bacterial infections were transferred to the hospital’s laboratory, 880 (33.2%) of which were positive for bacterial infections. The maximum antibiotic resistance rate against an antibiotic was observed to be 58% for Staphylococcus aureus (erythromycin), 75% for Klebsiella pneumonia (ampicillin/sulbactam), 64.5% for Escherichia coli (imipenem), 76.2% for coagulase-negative Staphylococcus (vancomycin), 100% for Acinetobacter baumannii (imipenem), 52% for S. epidermidis (erythromycin), 85.9% for Enterobacter species (gentamycin), and 65.6% for Pseudomonas aeruginosa (ampicillin/sulbactam). The overall rate of multi-drug resistance was obtained as 27.6%.

 A high rate of resistance of various bacterial strains to common antibiotics, especially erythromycin, ampicillin, imipenem, vancomycin, and gentamycin, was denoted in orthopedic wards. Also, a high rate of multi-antibiotic resistance was encountered in these wards, where more than a quarter of the bacterial strains showed such resistance.

Global real-time monitoring of SARS-CoV-2 variants is crucial to controlling the COVID-19 outbreak. The purpose of this study was to set up a Sanger-based platform for massive SARS-CoV-2 variant tracking in laboratories in low-resource settings.

We used nested RT-PCR assay, Sanger sequencing and lineage assignment for 930-bp of the SARS-CoV-2 spike gene, which harbors specific variants of concern (VOCs) mutations. We set up our platform by comparing its results with whole genome sequencing (WGS) data on 137 SARS-CoV-2 positive samples. Then, we applied it on 1028 samples from March-September 2021.

In total, 125 out of 137 samples showed 91.24% concordance in mutation detection. In lineage assignment, 123 out of 137 samples demonstrated 89.78% concordance, 65 of which were assigned as VOCs and showed 100% concordance. Of 1028 samples screened by our in-house method, 78 distinct mutations were detected. The most common mutations were: S:D614G (21.91%), S:P681R (12.19%), S:L452R (12.15%), S:T478K (12.15%), S:N501Y (8.91%), S:A570D (8.89%), S:P681H (8.89%), S:T716I (8.74%), S:L699I (3.50%) and S:S477N (0.28%). Of 1028 samples, 980 were attributed as VOCs, which include the Delta (B.1.617.2) and Alpha (B.1.1.7) variants.

Our proposed in-house Sanger-based assay for SARS-CoV-2 lineage assignment is an accessible strategy in countries with poor infrastructure facilities. It can be applied in the rapid tracking of SARS-CoV-2 VOCs in the SARS-CoV-2 pandemic.

The prevalence of glomerular diseases, as the leading cause of chronic kidney disease, is increasing. Renal biopsy is still the gold standard for diagnosis of the most kidney disorders. Data on prevalence of the biopsy-proven kidney diseases in Iran is limited and none of the previously reported studies used electron microscopic (EM) evaluation for the diagnosis. This study was conducted to analyze the prevalence of biopsy-proven kidney diseases in a referral center in Iran.

The reports of kidney biopsy samples from 2006 to 2018 referred to a pathology center, affiliated with Tehran University of Medical Sciences were reviewed. The prevalence of different disorders was assessed based on the clinical presentation in 3 age categories, including childhood, adulthood, and elderly.

Among 3455 samples, 2975 were analyzed after excluding transplant-related specimens, suboptimal specimens, and those with uncertain diagnoses. Nephrotic syndrome (NS) (39%) was the most common cause of biopsy followed by subnephrotic proteinuria (18%), hematuria in association with proteinuria (15%), renal failure (9%), isolated hematuria (6%), lupus (4%) and the other non-specific manifestations such as hypertetion or malaise (each one less than 2%). The most common diagnoses included membranous nephropathy (MGN) (17.9%), focal segmental glomerulosclerosis (FSGS) (15.9%), lupus nephritis (LN) (13.7%), minimal histopathological findings (unsampled FSGS versus Minimal Change Disease, 12.1%), Immunoglobulin-A (IgA) nephropathy (6.5%) and Alport syndrome (6.1%). MGN was the most frequent disease before 2013, but FSGS became more frequent after that.

NS and proteinuria were the most indications for kidney biopsy. Although MGN was the most common disease, the prevalence of FSGS has been increasing in recent years and making it the most common disease after 2013. LN and IgA nephropathy are the most common causes of secondary and primary GN presenting with proteinuria and hematuria, respectively.

Since 2019, Coronavirus has been a highly contagious disease. The COVID-19 outbreak was declared a pandemic by the World Health Organization in March 2020. Variable laboratory findings are reported in COVID-19 patients, among which elevated levels of D-dimer, lactate dehydrogenase, as well as lymphopenia, have been reported to be associated with increased severity of disease symptoms requiring ventilator support, intensive care unit admission, and mortality.

In the current study, inclusion criteria were: patient age above 18 years and hospitalization in the Imam Khomeini hospital with COVID-19 disease confirmed with nasopharyngeal swab polymerase chain reaction tests. Levels of white blood cells, neutrophils, lymphocytes, hemoglobin, platelets, D-dimer, C-reactive protein, LDH, and ferritin were measured and their correlation with the final patients’ outcome was evaluated.

A total of 208 patients were included in the present study. Higher neutrophil to lymphocyte ratio, (WBC count excluding lymphocyte)/lymphocyte, LDH, platelet to lymphocyte ratio, ferritin, and D-dimer were significantly related to O2 dependency. Neutrophil to lymphocyte ratio, (WBC count excluding lymphocyte)/lymphocyte and LDH were significantly related to higher rates of mortality. Higher Hb and lymphocyte count were significantly related to higher rates of survival.

Hematological parameters including neutrophil to lymphocyte ratio, (WBC count excluding lymphocyte)/lymphocyte, LDH, platelet to lymphocyte ratio, ferritin, D-dimer, Hb, and lymphocyte count were significantly related to the prognosis of patients with COVID-19 disease. This could help decide which COVID-19 patients have priority for hospitalization and intensive medical care, particularly when the pandemic disease causes limitations in healthcare service.

In recent years, the Internet of Things (IoT) networks have extensively been used in various practical field, one of the most important of which is medical Internet of Things (MIoT). In these networks, radio frequency identification (RFID) is one of the main technologies in creating an authentication system that is able to efficiently identify and identify medical equipment and patients. Therefore, researchers in this field have proposed different authentication protocols for RFID-based MIOT systems and claimed that they are resistant to active and passive attacks. Contrary to their claims, most of these protocols are not resistant to conventional attacks. Fan et al. have recently proposed a lightweight RFID authentication scheme for cloud-based RFID health-care systems and claimed that it is sufficiently efficient and secure. In this paper , we analyzed the Fan et al protocole and demonstrated that their protocol is vulnerable to replay, reader impersonation, tag tracking, and de-synchronization attacks. Moreover, we show how the similarity of some of their protocol messages causes attack. Then, we propose an improved protocol (LRAMP) that is resistant to these and other known attacks in RFID authentication protocol. According to security analysis, we can see that the LRAPM protocol has a high level of security. This high security can only be achieved by adding a new message and changing other messages. A comparison of the performance of the LRAPM protocol shows that this protocol is comparable to similar protocols in terms of computational costs, storage costs and communication costs.

Candidemia is a major cause of morbidity and mortality among patients receiving immunosuppressive therapy and those hospitalized with serious underlying diseases. Here, we investigated the epidemiological, clinical and mycological features of candiemia in Tehran, Iran.

A prospective observational study of all patients diagnosed with candidemia was performed at two referral teaching hospitals in Tehran, Iran between February to December 2018. Demographic characteristics, underlying diseases, risk factors, clinical symptoms, and laboratory analyses of candidemic patients with positive culture were mined. Candida isolates were molecularly identified by sequencing of the internal transcribed spacer region (ITS1-5.8S-ITS2). The antifungal susceptibility testing for fluconazole, itraconazole, voriconazole, posaconazole, amphotericin B, caspofungin, micafungin and anidulafungin against the isolates were performed using CLSI broth microdilution reference method (M27-A3).

A total of 89 episodes were identified, with an incidence of 2.1 episodes/1000 admissions. The most common underlying disease was sepsis (48%) followed by malignancy (46%), renal failure/dialysis (44%), and hypertension (40%). The overall crude mortality was 47%. C. albicans (44%) was the most frequent causative agent followed by C. glabrata (21%), C. parapsilosis complex (15%), C. tropicalis (11%), and C. lusitaniae (3.5%). All the isolates were susceptible to amphotericin B. The activity of all the four azoles was low against non-albicans Candida species, especially C. tropicalis.

Increase in non-albicans Candida species with reduced susceptibility to antifungal drugs might be alarming in high-risk patients. Therefore, accurate knowledge of predisposing factors and epidemiological patterns in candidemia are effective steps for managing and decreasing the mortality rate in candidemia.

A new proof identifies precisely how large a mathematical graph must be before it contains a regular substructure.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus. The first known receptor for this virus in the human body is angiotensin-converting enzyme 2 (ACE2), the same receptor for the SARS virus.

A total of 38 hospitalized adult (18 years) patients with laboratory or clinically confirmed coronavirus disease 2019 (COVID-19) were identified in the infectious disease ward of Tehran Imam Khomeini hospital complex in this single-center cross - sectional study. A blood sample was taken at the time of hospitalization and a second one was taken 48 hours later. Blood samples are kept frozen at -80 degrees Celsius. After the complete collection of samples, the ACE2 level of the samples was measured using a serum sACE2 detection ELISA kit. The data were analyzed using SPSS v26. P value of 0.05 was considered statistically significant. An analysis of covariance was performed to examine the mean differences in day 7 serum ACE2 concentration among the 2 groups after adjusting for the baseline serum ACE2 concentration. The 1-way multivariate analysis of variance was used to determine whether there were any differences between independent groups (mechanical ventilation yes/no) on serum ACE2 levels at 3 different times.

The mean age of patients was 64.13 ± 16.49 years, 21 patients (55.3%) were men, 16 patients (42%) were polymerase chain reaction test positive, and 15 patients (39.5%) died. A total of 35 individuals (92.1%) had chest computed tomography images that indicated lung involvement. A comparison of the 2 groups of patients who died and were discharged revealed that serum ACE2 at the first (p=0.033) and third (7th day) measurements were statistically different (p=0.026). Patients had a mean of serum ACE2. The results indicated that the day 7 serum ACE2 concentration did significantly differ between the 2 groups after controlling for the baseline serum ACE2 concentration (p=0.023). The model explained about 73.61% of the variance in the 7-day serum ACE2 concentration. Specifically, after adjusting for the baseline concentration, survived patients had the lowest level of serum ACE2 concentration (1 ± 0.65) on the 7th day compared with the deceased patient group (2.83 ± 1.12).

Soluble ACE2 in the serum of COVID-19 patients who died, later on, was significantly higher than the discharged patients when the samples were taken seven days after admission. It is suggested that serum soluble ACE2 level could be used as a prognostic factor for COVID-19 patients’ outcomes and also their need for mechanical ventilation.