masoud mardani

Antimicrobial resistance (AMR) has been a concerning public health issue even before the coronavirus disease 2019 (COVID-19) outbreak. However, the impact of the COVID-19 pandemic on AMR has not been comprehensively investigated.

The main objective of this study was to investigate the patterns of AMR before, during, and after the COVID-19 pandemic.

Data from hospital records of cancer patients in the hematology ward were obtained for this cross-sectional study using a census sampling method from January 2018 to July 2023. Clinical specimens were collected, including urine, stool, cerebrospinal fluid, ascites, pleural fluid, oropharynx, blood, and synovial fluid. All specimens were sent to the central laboratory of the hospital. The obtained samples were cultured on blood agar (Merck) and MacConkey agar (Merck) media and incubated for 24 hours. The classification of strains as resistant, intermediate, or susceptible was determined according to the Clinical and Laboratory Standards Institute (CLSI) guidelines.

In the present study, 382 isolates were obtained from 186 (48.7%) males and 196 (51.3%) females admitted to the hematology ward at Taleqani Hospital. Among the 382 isolates, 102 were Escherichia coli , 97 were Klebsiella pneumoniae , 51 were Pseudomonas aeruginosa , 49 were coagulase-negative Staphylococcus , 30 were S. aureus , and 53 were other species. There was a changing trend in the antibiotic susceptibility patterns of ceftazidime for coagulase-negative Staphylococcus , as well as in multiple agents including meropenem, amikacin, and piperacillin-tazobactam for P. aeruginosa . For K. pneumoniae , there was a significant change in the antibiotic susceptibility patterns for amikacin, piperacillin, and ceftriaxone. For S. aureus , a significant difference was observed in the antibiotic susceptibility patterns of meropenem and clindamycin. For E. coli , significant differences were found in antibiotic susceptibility patterns for imipenem, amikacin, and cefazolin.

Although we have navigated through the COVID-19 pandemic, its consequences, such as altered trends in AMR, continue to pose challenges to the healthcare system. Coronavirus disease 2019has influenced the resistance patterns of both gram-negative and gram-positive bacteria. Monitoring adherence to guidelines is crucial to prevent further spread of resistant strains, particularly in developing countries where improvements in attitudes toward antibiotic prescription and hygiene standards are needed.

Providencia species are opportunistic pathogens that can rarely cause nosocomial infections. They possess numerous virulence characteristics, such as intrinsic antibiotic resistance, which enable them to cause lethal outbreaks. The emergence of pan-drug resistant (PDR) isolates amplifies the threat of Providencia spp. to human health.

We described an outbreak caused by PDR Providencia spp. in the intensive care unit (ICU) of our medical center.

This outbreak occurred at Imam Hossein Hospital in Tehran, Iran, between 20 June and 28 July 2023. The majority of the 14 patients experienced ventilator-associated pneumonia (VAP); however, two others had surgical site infections (SSI) and peritoneal abscesses. Samples were subcultured on Blood agar, Chocolate agar, and MacConkey agar, as well as differential gallery mediums. Additionally, susceptibility to antimicrobial agents was determined by the disk diffusion protocol using Mueller-Hinton (MH) agar.

The rapid diagnosis of the outbreak and practical measures recommended by the infection prevention and control (IPC) committee (e.g., sampling from other patients, hands of healthcare workers, and the environment to identify further cases and the source of the infection, contact isolation, disinfection of the ICU with 1% chlorine solution, and combined antibiotic therapy) assisted us in managing it. Nevertheless, the outbreak resulted in the mortality of eight patients, despite these preventive and therapeutic measures.

Clinicians should be aware of nosocomial infections caused by opportunistic pathogens such as Providencia spp., especially in ICU-admitted patients with prolonged hospitalizations and broad-spectrum antibiotic administration. Strong clinical suspicion and timely detection of outbreaks, investigation of further cases, contact isolation of infected patients, disinfection of the environment, treatment with combined antibiotic regimens, and re-sampling of patients and the environment are the cornerstones of managing outbreaks caused by Providencia spp.

Evacuated tube solar collectors (ETSC) are widely utilized in both domestic and industrial solar water heaters (SWH) due to their commendable thermal performance and straightforward installation. However, a significant challenge associated with ETSC lies in the fact that half of the collector remains unexposed to sunlight. To overcome this limitation, parabolic reflectors can be employed as a viable solution. The primary objective of this study is to assess the performance of a compound parabolic concentrator (CPC) in conjunction with ETSC, taking into account a specific ratio between the areas of the CPC and ETSC. To achieve the desired configuration, the CPC was meticulously designed, fabricated, installed, and subsequently tested. Moreover, the energy performance of the absorber tube was scrutinized both with and without the integration of a parabolic trough collector. The experiments and data collection were conducted on two selected days for both the conventional ETSC device and the system incorporating the CPC. Meteorological data and operational conditions were measured and digitally stored for subsequent analysis. A noteworthy outcome of the study is the revelation that the energy efficiency of the system with a concentrator exhibited a notable improvement of 2.8% compared to the conventional system. Offline results further indicated that the performance of a single absorber tube with a concentrator increased by approximately 2.7 times when compared to the standard system. This suggests that the energy performance of the solar water heater, with a capacity of about 200 liters and featuring 7 absorber tubes with a concentrator, is comparable to that of the conventional system equipped with 18 absorber tubes.

In this research study, a cost-effective and reliable weather station using a microcontroller system containing instruments and sensors for measuring and recording ambient variables was designed, fabricated, and tested. The dataset recorded and stored in the meteorological system can be applied to conduct various research in the field of energy and environment, especially in solar systems. Employing a microcontroller system reduces costs and provides special features such as accessing data on the web-based spreadsheets and adding control devices. In this system, meteorological information including solar radiation, air temperature, wind velocity, and air relative humidity is measured and saved in user-defined time intervals such as 30 seconds. The total cost for measuring equipment, sensors, and microcontroller along with a data logger is about 110 USD. To demonstrate the importance of using local meteorological data, in the vicinity of the case studies, the dataset provided by the local weather station was compared with the meteorological data of two nearby national stations for one month. The results revealed that the values reported by the national stations were different from the actual values measured by the local weather station. The deviations for solar radiation, wind velocity, air temperature and humidity values were at least 5, 9, 7%, and more than 100%, respectively.

Mucormycosis is an aggressive opportunistic fungal infection that afflicts patients with severe underlying immunosuppression, uncontrolled hyperglycemia and/or ketoacidosis, iron overload, and occasionally healthy patients who are inoculated with fungal spores through traumatic injuries. The epidemiology of mucormycosis has changed after the COVID-19 pandemic, with mucormycosis becoming the most common and the fatal coinfection

In a retrospective, cross-sectional study, 82 hospitalized patients with a definite diagnosis of mucormycosis were reported from 2007 to 2021 in a referral, tertiary care center in Tehran, Iran

The number of post-COVID cases increased 4.6 times per year, with 41.5% of patients admitted during the two years of the pandemic. Mucormycosis was more common in women (57.3%), and the most common underlying diseases were diabetes (43.7%), both COVID-19 and diabetes (23.2%), cancer (11%), rheumatic diseases (7.3%), COVID-19 without other underlying diseases (6.1%), and transplantation (4.9%). Rhino-orbito-cerebral Mucormycosis (54.9%) followed by Sino-orbital infection (23.2%) was the most common presentation. There was a significant relationship between the use of immunosuppressive agents and the development of Mucormycosis (P<0.005) The average mortality was 41.5%, but this ratio decreased to 35% during the pandemic era.

The COVID-19 pandemic caused a 4.6-fold increase in the number of mucormycosis patients, and there was a significant relationship between hyperglycemia, corticosteroid use, and mucormycosis. The death rate during the COVID-19 pandemic has decreased by 6.5%, and during the COVID period, the interval between the arrival of a patient with mucormycosis and the start of the correct treatment was significantly decreased.

Infectious agents are considered as a possible cause of schizophrenia. The aim of this study was to evaluate the serum levels of cytomegalovirus (CMV), Toxoplasma gondii and Brucella antibodies in schizophrenia patients compared with the control group.

This cross-sectional study was performed on 75 patients with schizophrenia who were clinically diagnosed with schizophrenia using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by two independent psychiatrists. As the controls, 75 sex and age-matched individuals were selected from orthopedic and surgical wards, who were admitted because of trauma. Anti-Toxoplasma gondii IgG antibody was detected by Abbott's company diagnostic kit. To detect anti-Brucella IgG antibodies, the enzyme-linked immunosorbent assay (ELISA) test with Vircell diagnostic kit was used. Quantitative luminescence (CLIA) method using Abbott diagnostic kit was also used to detect anti-cytomegalovirus IgG antibody (CMV IgG avidity).

There was not any clinically significant differences in the mean value of Toxoplasma, CMV and Brucella IgG antibodies between schizophrenia and control group. However, considering cut-off point for these tests and further analysis with non-parametric tests showed clinically significant difference between two groups at cut-off point 1.1 for anti-Brucella IgG antibody which indicated more positive samples in schizophrenia group (24 out of 75) than control group (12 out of 75) with a p-value less than 0.05 (0.046).

The results of the present study showed no association between toxoplasmosis infection and CMV and schizophrenia. However, there might be a positive correlation between anti-Brucella IgG antibody and schizophrenia.

Migraine is known as one of the most debilitating diseases with high prevalence worldwide. This study aimed to compare between combined administration of ginger and Depakene (sodium valproate) capsules (intervention group) and the use of Depakene (control group) alone to evaluate the therapeutic efficacy of ginger in the treatment of migraine.  This randomized one-blind clinical trial was conducted with 80 patients suffering from migraine headaches. A total of 40 patients in the intervention group received two ginger capsules of 250mg manufactured by Zintoma (Gol Darou Co.) along with 500 mg Depakene orally daily for sixteen weeks, and 40 patients in the control group received Depakene (500 mg/d) alone. The variables included the severity of the headache, the number of headaches per month, and the sleep quality of patients. Data were analyzed using descriptive statistics: frequency, percentage, mean and standard deviation, and analytical statistics: χ2, independent t test, and pair t tests.  For pain intensity, the mean score of pain after the intervention in the intervention group was significant so that it was lower than the mean score in the control group (P < 0.05). Moreover, there were significant differences in disability severity induced by migraine headaches between the two groups after the intervention so that it was lower in the intervention group than in the control group (P < 0.05).  Administration of the ginger capsule (500 mg) with Depakene (500 mg) was considered to improve pain severity, disability, and sleep pattern in patients with migraine compared to administration of Depakene alone. Therefore, this combination therapy can be considered a choice in the treatment of these patients.

 MRSA, or methicillin-resistant Staphylococcus aureus, has arisen as a nosocomial and community-acquired infection throughout the world. MRSA identification in the laboratory is difficult for a variety of reasons. The aim of this study was to investigate several phenotypic methods for the detection of MRSA compared with the PCR-based method as the gold standard.

 A total of 220 clinical isolates of S. aureus were recovered from diverse clinical specimens between August 1, 2019 and June 30, 2020 at Milad Hospital in Tehran, Iran. Cefoxitin discs, CHROMagar™ MRSA medium, and identification of the mecA gene by Polymerase Chain Reaction (PCR) as the gold standard method were used to assess methicillin resistance.

PCR testing revealed that 105 (47.72%) of 220 S. aureus isolates were positive for the mecA gene. The results of the Cefoxitin disc diffusion method showed that it has similar sensitivity and specificity to PCR method. The sensitivity and specificity of CHROMagar™ MRSA medium were both 100%. The Cefoxitin disc diffusion method had the same sensitivity and specificity as the PCR method for detecting the mecA gene. For MRSA detection, the Cefoxitin disc diffusion method can be employed as an alternative to PCR.

Community-acquired pneumonia (CAP) refers to pneumonia attained outside the hospital or less than 48 hours before admission, which is a significant cause of mortality and morbidity, especially in major comorbidities and older age. Several microorganisms contribute to developing CAP, primarily Streptococcus pneumonia, Haemophilus influenza, Moraxella catarrhalis, and atypical pathogens, e.g., Mycoplasma pneumonia. The incidence of these microorganisms depends on outpatient or inpatient settings. Administering appropriate treatment among available antibiotics is a critical issue affecting patient survival.

With a multidisciplinary panel expert, this document offers evidence-based recommendations for managing CAP in Iran.

The document evaluated the availability of antimicrobial agents and local antibiotic resistance patterns based on 94 relevant published studies from Google Scholar, Scopus, PubMed, Scientific Information Database (SID), Iran Medex, Iran doc, Mag Iran, PubMed, and expert opinions.

The panel addressed two main parts of rational recommendations for managing outpatients or hospitalized patients with CAP.

Context: 

The current pandemic of COVID-19 affected all people of the world.

Evidence Acquisition:

 Most complications of SARS-CoV-2 are causally related to severe pneumonia due to host immune response in the form of a cytokine storm. The other causes of an increased mortality rate among COVID-19 patients are secondary infections.

 Mucormycosis is a life-threatening infection that gained much attention in the ongoing COVID-19 pandemic. A rise in the frequency of COVID-19-associated mucormycosis (CAM) occurred in 2020 and 2021. Overall, mortality of CAM has been reported as 54% - 75%.

 Although awareness of the disease has increased among treating physicians, disease-associated morbidity and mortality are still high. The guideline is intended to serve as a reference to prevent mucormycosis in COVID-19 patients and help healthcare providers choose diagnostic and treatment methods for the best management of CAM cases.

Cerebral mucormycosis (CM) is a life-threatening manifestation of mucormycosis, an angioinvasive fungal infection caused by Mucorales. We sought to systematically review all available case reports to describe epidemiologic features, clinical manifestations, predisposing factors, and diagnostic and treatment strategies of CM. A systematic search was conducted using a combination of the following keywords: "Mucor", "Zygomycetes", "mucormycosis", "cereb*", "brain", "central nervous system", and "intracranial", separately and in combination until  December 31st 2018. Data sources included  PubMed, Scopus, EMBASE, Web of Science, Science Direct, and Proquest without limiting the time of publication. We included 287 articles corresponding to 345 cases of CM. Out of the 345 cases, 206 (60%) were male with a median age of 44 years; 130 (38%) were reported from North America; 87 (25%) from Asia; and 84 (24%) from Europe. The median time from onset of symptoms to presentation was 3-7 days (65/345, 65%). The highest mortality was observed among patients with diabetes mellitus (P=0.003). Debridement of infected brain tissue was associated with improved survival in CM cases (OR 1.5; 95% CI 01.3-1.8; P<0.0001). The use of liposomal amphotericin B (L-AMB) was significantly associated with patients' recovery (OR 2.09; 95% CI 1.2-3.4; P=0.003). The combination of L-AMB and posaconazole (12.5%) was more effective than the monotherapy treatment of CM cases (P=0.009). Clinicians should consider DM as an important risk factor for CM. Moreover, surgical debridement and antifungal combination therapy could be an effective approach in the management of CM patients.