mohammadreza salehi

Primary pyogenic spinal infection, also known as spondylodiscitis or vertebral osteomyelitis, is a serious and potentially debilitating condition involving a bacterial or fungal infection of the intervertebral disc space and adjacent vertebral bodies. While relatively uncommon, with an estimated incidence of 2.4 per 100,000 population per year, it is a medical emergency that requires prompt diagnosis and treatment to prevent permanent spinal damage and neurological complications. The most common causative organisms are Staphylococcus aureus, which accounts for up to 50% of cases, followed by Gram-negative bacteria such as Escherichia coli, and mycobacterial infections like Mycobacterium tuberculosis. Risk factors for developing primary pyogenic spinal infection include intravenous drug use, a weakened immune system, recent spinal surgery or instrumentation, and contiguous spread from an infection elsewhere in the body, such as a urinary tract infection or endocarditis. Patients typically present with severe, localized back pain, fever, and general malaise, which can easily be mistaken for more common spinal conditions. Prompt diagnosis is critical and involves a thorough medical history, physical examination, laboratory testing, and advanced imaging studies such as magnetic resonance imaging (MRI). Blood cultures and, in some cases, image-guided biopsy may be necessary to identify the causative organism and guide appropriate antimicrobial therapy. The mainstay of treatment is the prompt initiation of targeted antibiotic or antifungal therapy, often requiring intravenous administration for several weeks. Surgical intervention may be necessary in some cases, such as to drain an abscess or provide spinal stabilization. A multidisciplinary approach involving infectious disease specialists, spine surgeons, and rehabilitation providers is essential for optimal management and outcomes. Despite advances in diagnosis and treatment, primary pyogenic spinal infection remains a challenging condition. Delays in diagnosis and treatment can lead to devastating complications, including permanent spinal deformity, paralysis, and even death. With timely and appropriate management, however, most patients are able to achieve a good clinical outcome, though some may experience residual pain or neurological deficits.

AbstractDuring wars, hospitals, medical staff, and civilians are protected by International Humanitarian Law (IHL). However, this importance is not observed in some instances. We examined the killing of medical staff and attacks on medical facilities during the Gaza war. In this scoping review, we gathered data from primary and secondary sources, such as newspapers, peer-reviewed journals, open-source platforms, social networks, and Non-Governmental Organization (NGO) websites from October 27, 2023 to May 21, 2024. Additionally, we collected data from some organizations, such as Physicians for Human Rights (PHR), the World Health Organization (WHO), Palestine Ministry of Health, World Bank, and United Nations Children’s Fund (UNICEF).According to different reports, between 400 to 800 incidents of violence against the healthcare services were documented in Gaza from the start of the war on October 27, 2023 until May 21, 2024. These incidents include obstruction of access to medical facilities, attack on ambulances, damage to hospital buildings, and targeting of medical staff and healthcare volunteers. Although the WHO issued warnings to stop the violence against medical staff and health facilities, these efforts were unsuccessful.The results revealed that unprecedented tragedies are occurring in Gaza, where medical facilities and staff are being targeted and killed. However, the response of international organizations appears to be passive and not appropriate to the extent of the war crimes. Moving forward, the international community should consider developing more effective solutions to address criminal behavior within the healthcare sector.

Increased serum concentrations of inflammatory biomarkers in patients indicate a strong association between COVID-19 and inflammation. However, the association between diet-related inflammation and COVID-19 has been less investigated. The aim of this study is to investigate whether the inflammatory scores of the diet are associated with the severity of COVID-19 disease and the probability of hospitalization of patients. 

The authors conducted a cross-sectional study involving 141 patients with COVID-19. The empirical dietary inflammatory pattern (EDIP) and dietary inflammation scores (DIS) were calculated based on a 147-item semi-quantitative food frequency questionnaire. The association between serum levels of inflammatory biomarkers and diet-related inflammation was also investigated.

74 inpatients and 87 outpatients participated in this study. Higher DIS scores were significantly associated with an increased risk of COVID-related hospitalization (Tertile3 vs. tertile1: OR = 3·62; 95 % CI 1·43 to 9·14, P=0·008 after fully adjustment). This association with EDIP was also observed, but it was not significant.

The data from this provide evidence that a pro-inflammatory diet was associated with higher risk of hospitalization due to high severity of COVID-19

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.

 The correct identification of Candida species is one of the most critical procedures in prognostic and therapeutic significance, allowing an early and appropriate antifungal therapy. This study aimed to evaluate multiplex PCR as a rapid diagnostic method and traditional phenotypic tests in identifying Candida species isolated from candidemia cases.

 In this study, 38 Candida spp were isolated from culturing of human blood obtained from patients suspected to candidemia. The isolated species were evaluated by phenotypic and molecular methods including carbohydrate assimilation test, colony colour on CHROMagar Candida, chlamydoconidia production, germ tube formation and Multiplex PCR. Multiplex PCR was performed using specific primers of 4 common species. The results of multiplex PCR were compared with those obtained from phenotypic tests.

 According to multiplex PCR findings, the isolated Candida species were identified as C. albicans, C. parapsilosis, C. glabrata, and C. tropicalis. Phenotypic tests identified that 23 (60.52%), 8 (21.05%), 5 (13.15%), and 2 (5.26%) isolates belonged to C. albicans, C. parapsilosis, C. glabrata, and C. tropicalis, respectively, that were confirmed by multiplex PCR results. C. albicans and C. parapsilosis had the same carbohydrate assimilation pattern but were differentiated based on their colonies color on CHROMagar and the ability of C. albicans to produce chlamydoconidia and germ tube. C. glabrata (100%) and C. tropicalis (100%) assimilated trehalose and cellobiose, respectively.

 Our study showed that the both phenotypic and molecular techniques provide appropriate information for identification of Candida spp from blood samples.

Healthcare-associated infections (HAIs) in intensive care unit (ICU) patients significantly complicate the normal hospitalization process and affect patients’ condition, length of hospitalization, mortality, and treatment cost. In this study, we aimed to determine the prevalence and economic burden of HAIs.

The study involved all patients with a confirmed HAIs (based on CDC/NHSN case-definitions); in the general ICU of a tertiary university hospital in Tehran, from April 2020 to March 2021. The patients’ information, including length of hospitalization, outcome, type and cost of prescribed antibiotics, were recorded.

During the study period, 119 HAIs were found in 1395 (43% F / 57% M) patients. The prevalence of nosocomial infections was 8.53%. The mean duration of hospitalization in all ICU patients was 4.7 ± 3.1 days, and 31.85 ± 18.96 days in patients with HAIs. The most common organisms involved in HAIs are Acinetobacter baumannii (54.6%), Klebsiella pneumoniae (30.3%), E. coli (15.1%), and Enterococcus spp. (12%). Incidence density of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI), and catheter-associated urinary tract infection (CA-UTI) per 1000 device-days were 36.08, 17.57, and 8.86, respectively. The total cost of antibiotics for HAIs was € 105,407. Among these, the highest consumption costs were for carbapenems, followed by colistin and caspofungin.

This study showed the high burden of nosocomial infections in ICUs. Strategies for more strict infection prevention and control are necessary to reduce this burden.

COVID-19 vaccine side effects predominantly affect public confidence in vaccination. Therefore, this study evaluated the rate and severity of adverse reactions associated with the COVID-19 Sputnik V vaccine among tertiary healthcare providers in an academic medical center.

This retrospective observational study was carried out from March 2021 to August 2021 among Imam Khomeini Hospital Complex healthcare workers, a tertiary referral healthcare center affiliated with Tehran University of Medical Sciences. Participants provided demographic and clinical information through a validated questionnaire after being interviewed. The frequency, severity, and outcome of all reactions after vaccination were recorded. The study utilized SPSS software, version 24.0 to conduct descriptive statistics on baseline variables and inferential statistics to examine associations between vaccine side effects and gender, medical history, and COVID-19 history of the participants. Additionally, ordinal regression analysis was employed to identify factors predicting the severity of adverse effects after the first and second doses of the Sputnik V vaccine.

A total of 372 participants (54.3% female) with a mean age of 36.5±9.18 years were recruited. The rate of at least one side effect was 77.15% and 57.8% after the first and second doses, respectively. The most common side effects among participants were myalgia (48.4% after the first and 28.2% after the second dose), injection site pain (26.3% after the first and 12.6% after the second dose), and fever (19.6% after the first and 12.9% after the second dose). The higher rate of fever and myalgia after the first dose was observed among subjects with a history of COVID-19. 

Among healthcare workers, the side effects following the first and second doses of the Sputnik V vaccine were primarily mild, with no cases requiring hospitalization. Further research is required to assess potential side effects in larger and diverse populations with varying demographic and social characteristics.

The incidence of invasive aspergillosis (IA) has significantly increased in recent decades. In patients with hematologic malignancies (HM), IA is associated with higher mortality rates.

This study aimed to assess the clinical features of IA in patients with HM.

In this retrospective study, we utilized the hospital information system (HIS) database to extract clinical and paraclinical characteristics of patients with variousHMswhoreceived a diagnosis of probable or proven IA during their hospitalization atImam Khomeini Hospital Complex in Tehran, Iran, between March 2018 and March 2022

Among350 patients withHMevaluated, 51 patients (14.6%) were identified as having IA, including 40 cases (78.4%) classified as probable and 11 (21.6%) as proven. Among these, 34 individuals (66.7%) were male. The most common symptoms included fever (n = 23, 62.7%), cough (n = 20, 39.2%), and fever that did not respond to antibiotic therapy (n = 16, 31.4%). The most prevalent malignancies wereAML(n = 28, 54.9%), ALL (n = 16, 31.4%), andlymphoma(n = 7, 13.7%). Out of the 51 patients withHMand IA, 48 (94.1%) had abnormal findings on chest CT scans, with the majority (n = 31, 72.1%) showing a nodule with a halo sign. Aspergillus flavus (n = 19/24, 79.2%) was the most commonly isolated species. Initially, patients received liposomal amphotericin B or caspofungin as empiric antifungal therapy, which was then switched to voriconazole once the diagnosis of IA was probable or proven. Eight patients (15.6%) did not survive.

Patients with HM presenting with fever and cough should undergo close monitoring for IA. A higher incidence of IA is observed in AML patients, and voriconazole could be considered as antifungal prophylaxis in HM patients. A. flavus is likely the most frequent cause of IA in Iranian patients with HM.

 Invasive fungal infections (IFIs) are a significant cause of mortality and morbidity in patients with hematological malignancies. Given the considerable prevalence and consequences of IFIs, hence revealing the exact cause of fungal infections, their rate, associated risk factors, and complications could contribute to reducing both financial and life costs, choosing targeted antifungal treatment, and avoiding unnecessary toxic treatments in individuals who are not suffering from mycoses.

 This prospective cross-sectional study was conducted in the first semester of 2019. All patients with hematologic malignancies (HM) admitted to Dr. Shariati Hospital were studied. Only those with probable/proven IFIs defined according to the last update of EORTC/MSG criteria were included in the study. The demographic and clinical data were recorded from the hospital information registration system using a questionnaire. Statistical analysis was performed using SPSS software version 24.

Out of 1109 HM patients hospitalized during the study period, 67 (6.04%) IFIs were diagnosed. Of these, 57 (85.04%) were aspergillosis, 7 (10.4%) were mucormycosis, and 3 patients developed other fungal infections. Males constituted 67.2% of the entire IFI population. The mean±SD age of the samples was 43.16 ± 13.8 years. The most common type of malignancy was AML. Lung imaging showed lesions associated with fungal infections in 52 cases (77.6%), with multiple nodules as the most prevalent pattern being observed in 64.2% of cases. Sinus involvement was evidenced in the PNS CT scan of 46 (68.6%) patients. The attributable mortality rate for IFIs was 62.7%. Both the types of IFI and malignancies had no significant relationship with the outcome of patients. Central venous catheter, mucositis, and antibiotic use were the most frequent risk factors.

  IFI represents a frequent complication for HM patients with high mortality. Aspergillus species are the predominant etiology in these settings. Considering our results, in high-risk patients, manifestations of warning signs in the sinus and lungs, which would not be cleared despite receiving antibiotics, should raise the possibility of IFIs.

 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.

The diabetic foot is a chronic complication of diabetes. There is a strong relationship between glucose levels, the severity of diabetic foot ulcers (DFUs), and the need for amputation. This study aimed to evaluate the blood sugar (BS) trends before and after surgery in patients with DFU who had been amputated.

The adult patients who had undergone DFU-related amputation surgery between 2017 and 2020 in Imam Khomeini Hospital Complex, Tehran, Iran, were evaluated. The cases whose BS levels were charted at least three days before and after amputation were recruited. The main data, including hypoglycemia (defined as a blood glucose level < 70 mg/dl) and mean BS and fasting BS (FBS) levels, were recorded. The data were then analyzed and compared before and after amputation.

Of 267 patients reviewed for inclusion criteria, 55 patients were included in the study. Twenty-eight patients (50.9%) were men, and the mean age was 60 years. The mean FBS before and after amputation was 229.5 and 181.3 mg/dl, respectively, and the mean BS before and after amputation was 227.3 and 197.8 mg/dl, respectively. The differences were significant (P < 0.001). Twelve patients (21.8%) before and 21 patients (36.4%) after amputation suffered from hypoglycemia (P = 0.057).

DFU-related amputation is associated with a significant decrease in blood glucose levels and inflammatory indexes. However, it can increase the risk of hypoglycemia during the first three days after the surgery.

Despite the improvement in COVID-19 therapeutic management the mortality of mechanically ventilated COVID-19 patients remains high. In this study, we determined the risk factors of death in these cases. This cross-sectional study evaluated clinical and paraclinical features of mechanically ventilated COVID-19 patients at the time of hospital admission until death or discharge from hospital between April and September in 2021 in three COVID-19 referral hospitals. The patients were divided into survivors and non-survivors and then the characteristics were compared. One hundred twenty-five patients (60% male, mean age 62±15.18, range 17 to 97 years old) were recruited to the study. 51(40%) survived and 74 (60%) didn’t survive. At the time of hospital admission, the vital signs were not significantly different between the survivors and non-survivors, although diarrhea was not reported in non-survivors, but reported in 9.5% of survivors (P=0.02). The mean age of non-survivors was higher (65.1±14.17 vs 56.9±15.41, P=0.003). The intubation time since the patients were admitted was not significantly different between the two groups (3.38±2.88 days vs 4.16±3.42 days, P=0.34). The mean of serum LDH and D-dimer at the time of ICU admission were significantly higher in the non-survivors (863±449 vs 613±326, P=0.01; 4081±3342 vs 542±634, P=0.009; respectively). However, the mean CRP was not significantly different between the two groups (76±66.4, 54±84.3; P=0.1). Mean APACHE-II score was higher in the non-survivors than the survivors (15 vs 13; P=0.01). Use of remdesivir, interferon beta-1a, and low dose corticosteroids were significantly higher in the survivors group (P=0.009, P=0.001, P=0.000). Success of weaning and ICU discharge among mechanically ventilated COVID-19 patients are probably higher in younger patients with lower D-dimmer and LDH that received remdesivir, interferon beta-1a and low dose corticosteroids, while the intubation time did not seem to play a role on patients' outcome.

Although many treatments reduce cough and its complications, cough is still one of the most common and annoying problems of patients who refer to medical centers. Therefore, finding simple and effective treatments is of great interest to the medical community. This study aimed to determine the types of cough and find simple and effective therapies based on Persian medicine (PM).

This research is a kind of narrative review study. Firstly the keyword “soaal” (cough) in authentic Persian medical manuscripts was investigated using Jame Teb software version 1/5 of the Computer Research Center of Islamic Sciences [Noor]. After data gathering, types of coughs and their diagnostic signs and symptoms and appropriate treatments were identified and categorized. Data analysis was done by directed content analysis. Furthermore, some of the common recommendations were discussed from the point of view of conventional medicine.

Based on the results of this study, from the point of view of PM, there are different types of cough, including hot and cold post nasal discharge, hot, cold, humid, dry, cough caused by loud noise or dust, and smoke, cough caused by lung ulcer, swellings, participatory cough, and children's cough. The type is determined based on the patient's clinical symptoms and detailed history. The appropriate treatment is selected based on the type of cough, such as gargling, fumigation, anointment, warm compress with drug, bathtubs, poultice, decoction, cupping, leech, and phlebotomy.

Considering the wide range of treatments mentioned for different types of cough, it seems that using the opinions of PM and paying attention to the type of cough can open a new window for researchers to find new treatments.

The decision to perform tracheostomy during the COVID-19 pandemic has been based mainly on practical and empirical standards. Also, the amount of scientific evidence to determine the exact timing of tracheostomy in patients with severe COVID-19 on mechanical ventilation is not significant. We conducted a retrospective cohort study on mechanically ventilated COVID-19 patients from April 25, 2021 to January 25, 2022 in intensive care units of Imam Khomeini Hospital Complex, Tehran, Iran. The 30-day survival of patients was calculated and compared between patients under tracheostomy and those without tracheostomy. A number of 135 COVID-19 cases (75 patients in the intubated group and 60 patients in the tracheostomy group) were included in this study. The mean age of the population was 53.6±12.4. The overall mortality rate was 101 (74.8%). The 30-day mortality rate was significantly higher in the intubated group (90.6%) than in the tracheostomy group (55%) (P< 0.001). The mortality rate was 60% in the early (≤ 7 days) tracheostomy group and 50% in the late (>7 days) group. This difference was not statistically significant (P> 0.05). Tracheostomy is a preferred method in airway management of severe COVID-19 patients under mechanical ventilation; however, early tracheostomy during the first week of intubation may not be superior to late tracheostomy in decreasing the mortality rate.

Corticosteroid administration may impair blood sugar control and cause other adverse effects in pregnant women with moderate to severe COVID-19. To our knowledge, there have been no studies on the effect of corticosteroid therapy on pregnant women with COVID-19 infection in terms of hyperglycemia or insulin needs.

The purpose of this study was to compare 2 different regimens of corticosteroid therapy, specifically dexamethasone, and methylprednisolone, in terms of their impact on newly diagnosed hyperglycemia in pregnant women infected with COVID-19, as well as the duration of this condition.

The current cohort study was conducted from August to November 2021 on hospitalized pregnant women with severe COVID-19. They received either the first protocol, which involved daily administration of 2 mg/kg of methylprednisolone intravenously, or the second protocol, which included daily intravenous administration of 6 mg of dexamethasone. The study aimed to compare the incidence and duration of hyperglycemia until delivery between these 2 groups.

A total of 59 participants were recruited after meeting the inclusion criteria. There were no significant differences in the demographic and clinical characteristics of patients between the 2 groups. Among the 59 pregnant women included in the study, 24 (40.7%) developed hyperglycemia that required insulin therapy. The incidence of hyperglycemia did not significantly differ between the 2 treatment regimens (P-value = 0.069). In the follow-up period, hyperglycemia resolved in both groups within up to 4 weeks after treatment, and they no longer required insulin.

Corticosteroid-treated pregnant patients are associated with transient hyperglycemia, the incidence of which is unrelated to the type of corticosteroid used. Therefore, corticosteroid administration should be initiated with caution and monitored appropriately in pregnant women with COVID-19 infection. 

This study was designed to detect the therapeutic effects of galbanum oil plus dry cupping (a Persian medicine-based method) in hospitalized patients with coronavirus disease-2019 (COVID-19). In this randomized controlled trial, 60 hospitalized COVID-19 patients with positive polymerase chain reaction test (PCR), pulmonary involvement and blood oxygen saturation (SpO2) ≤93 mmHg, were randomly assigned into two groups to take the standard therapeutic regimen alone or alongside cupping and topical galbanum oil (Ferula gommosa oleo-gum resin) for 3-5 days. The SpO2 level, the severity of signs and symptoms of patients and laboratory parameters were compared between the two groups. Fifty-eight patients were analyzed. The SpO2 level changed from 89.27±3.82 to 90.29±3.09 mmHg (p=0.038) in control group, while it increased from 88.74±3.45 to 94.23±2.1 mmHg (<0.001) in galbanum group with a significant difference between the groups (p<0.001). Fever, cough, dyspnea, and anorexia alleviated in the galbanum group more than the control (p=0.003, 0.001, 0.01, and 0.04, respectively). No adverse effects were reported due to galbanum oil and cupping therapy. Dry cupping with galbanum oil alongside the routine therapeutic regimen could be more effective than the routine therapeutic regimen alone for improving SpO2 level and alleviating fever, cough, and dyspnea in COVID-19 patients.

Antibacterial resistance (AMR) is a serious threat and major concern, especially in developing countries. Therefore, we aimed to determine phenotypical patterns of resistance to antibiotics in COVID-19 patients with associated bacterial infection in intensive care units.

In this cross-sectional study, 6524 COVID-19 patients admitted for more than 48 h in the ICUs of Imam Khomeini Complex Hospital (IKCH) in Tehran from March 2020 to January 2022 were included in the study with initial diagnosis of COVID-19 (PCR test and chest imaging). Data were collected regarding severity of the illness, primary reason for ICU admission, presence of risk factors, presence of infection, length of ICU and hospital stay, microbial type, and antibiotic resistance. In this study, the pattern of antibiotic resistance was determined using the Kirby–Bauer disk diffusion method.

In this study, 439 (37.5%) were ventilator-related events (VAEs), and 46% of all hospitalized patients had an under- lying disease. The most common microorganisms in COVID-19 patients were carbapenem resistant Klebsiella pneumoniae (KPCs) (31.6%), Escherichia coli (E. coli) (15.8%), and Acinetobacter baumannii (A. baumannii) (15.7%), respectively. Prevalence of vancomycin-resistant enterococci (VRE) and KPCs were 88% and 82%, respectively.

A study on AMR surveillance is the need of the hour as it will help centers to generate local antibiograms that will further help formulate national data. It will guide doctors to choose the appropriate empiric treatment, and these studies will be the basis for establishing antimicrobial surveillance and monitoring and regulating of the use of antimicrobials.

We conducted this study to determine the safety and evidence of effectiveness of SeptimebTM among patients with COVID-19.

An uncontrolled phase II clinical trial with SeptimebTM was implemented in Imam Khomeini Hospital as a before-and-after trial during May to October 2020. Considering the inclusion and exclusion criteria, 33 patients with COVID-19 were treated using SeptimebTM. The patients received the anti-inflammatory drug 150 mg /10 ml /IV infusion SeptimebTM on the first day and then 300 mg /20 ml / IV infusion from the second day onwards for at least 2 days and up to 13 days based on the improvement of clinical symptoms and laboratory findings in addition to treatment which were selected according to the national protocol. The patients were then evaluated for the treatment efficacy and side effects. Adherence to treatment, clinical observations, and side effects were recorded before and after the treatment.

The herbal drug SeptimebTM was injected in phase two of an uncontrolled clinical trial on 33 patients with COVID-19 in Imam Khomeini Hospital in Tehran as a before-and-after trial. The number of new cases admitted to the Intensive Care Unit (ICU) and the new need to Non-Invasive Ventilation (NIV) ecreased compared to before the treatment. Also, blood oxygen saturation and platelet count increased. Conversely, CRP, ESR, and ferritin levels decreased (p<0.05). Besides, SeptimebTM did not show any serious side effects except recurrent thrombophlebitis during the treatment.

We found some evidence regarding the efficacy of this drug and its low amount of short term side effects. The investigators recommend conducting the third phase of the clinical trial.

Subacute thyroiditis is an uncommon thyroid disease which usually occurs after a viral infection. During COVID-19 pandemics, several subacute thyroiditis cases were identified during or after COVID-19. Due to their similar manifestations and high prevalence of COVID-19, subacute thyroiditis might be neglected if the clinicians do not keep it in mind. In this care report, we present a missing patient with SARS-COV-2 infection and subacute thyroiditis which was not suspected until the latent phase of the disease.The patient report can be a re-emphasis on the importance of clinical examination and especially paying attention to palpation of the thyroid gland.

Spacement poetry is a manifest-based movement in the history of contemporary poetry in Iran that follows specific patterns and structures. By reading Yadollah Royaee's ideas, the readers of spacement poetry become aware of its different philosophical, linguistic, and aesthetic capacities. Accordingly, the poetic of the image in Royaee's poetry is a complex of different capacities and aspects which takes its patterns and structures from spacement poetry. The aspects include lingual, phenomenological, aesthetic, and mystic, but achieving them is a problem that takes place through the manifest of spacement poetry and the historical development of Yadollah Royaee's opinions. Mysticism and its role in Royaee's poetry are also possible through these subjects as well as through concentration on the second manifest of spacement and the margins of this type of poetry. For this reason, the present study has achieved different levels of mysticism in ethics and mystical concepts by concentrating on the role of mysticism in this area. In other words, mysticism has found its roots in educating the spacement mind, reading, and writing with a mutual action in ethical aspects and then reached the structure of presence of the other, and objected the effects of mystical concepts through poems with emotional impulses, mystical language, and the context and the structure of 'Shathiyat'. In this regard, the authors focused on "Labrikhteha" and "Haftad Sange Ghabr", which are elaborated on in the study.

Poetic of the image in Yadollah Royaee's poetry is a mixture of various functions which have found their structure in stylistic patterns and features of this poet and also in mind education of spacement. This education is an abstract of patterns, spacement poetry manifests, and Royaee's ideas and have objected to different lingual, aesthetic, phenomenological, and mystical capacities through the effect of poetic of the image in Royaee's poem. Mysticism and its role in Royaee's poetry, as the pioneer of spacement poetry, have been achieved by concentrating on the poet’s ideas and going through the first manifest of spacement and focusing on the second one, which was a completion of different aspects of that manifest. Therefore, by focusing on the role of mysticism, the current research has studied its action in two aspects of ethics in mental education of spacement and of the mystic in patterns and stylistic features of Royaee's poem. In other words, this mystical role has a mutual action affected by Husserl's phenomenology from the ethical aspect and by the texture, atmosphere, and structure of the mystics Shathiyat. It is worth mentioning that the writers focused on "Labrikhteha" and "Haftad Sange Ghabr".

Review of the Literature:

In studying the role of mysticism in the poetics of the image in Yadollah Royaee's poem, the reader of spacement poetry faces a kind of philosophy-mysticism and finds its most important aspects in the effect of theory subjects of spacement poetry from Husserl's phenomenology, the language of Shathiyat, and the deep concepts of mysticism.
Here, the subject of Husserl's phenomenology connects with the ethical dimension. The feature of conscious experiences of humans finds its roots through Berentano in the Middle Ages back to Aristotle. In fact, by discussing ethics in his discussions, Husserl followed some subjects that reach the age of intellectualism of Europe through Kant and Heum and was accompanied by Plato and Aristotle (Smith, 2015). Yadollah Royaee has also mentioned this subject (ethics) in the second manifest of spacement and explained a mysticism rooted in ethics, then he reached Husserl's phenomenology. Ethics, passing ethics, clearance, and avoidance are repeatedly mentioned in the second manifest. Ethics is mixed with mental education of spacement. Moreover, "education of reading" is an important issue in which Royaee mentions the transference of the face and presents such an equation: "reading- transference of the face- studying" (Royaee, 2018, p. 180). It can be stated that spacement poets somehow practice spacement ethics that take them to avoidance, which means "clearness and avoidance" that itself reaches the structure of "the presence of the other" in Husserl's ideas. In fact, my connection with the world in Husserl's phenomenology represents in the spacement poetry stream via concepts like outside-being of me, outside-being of the world, transference of the face, spacement ethics, clearance, and avoidance. The laic mysticism issue which is also mentioned in the manifest somehow finds its roots in the philosophical effects of Husserl's phenomenology. Accordingly, concepts like doubt, rejection, and other are mentioned in the manifest, which all are rooted in the philosophical thinking of spacement poetry.
The effect of mystic concepts of the form and the structure of Shathiyat on the development of ideas in spacement poetry has been discussed and is clearly presented in "Labrikhteha" and somehow in "Haftad Sange Ghabr". That is why the poems of "Labrikhteha" are outstanding for their aesthetic form, mystical content, and the usage of mystic symbols, like the circle, spinning, other and so on, which are completely related to philosophical and aesthetic structure and the content of Shathiyat.
For example, in the following piece of the poem, the concepts of I and other are clearly outstanding:Whenever I am, comes from you
when all of me comes from all of you
I go away from what is me
and then it is something
runs to me.
(Royaee, 2008, p. 461)
Or in the following piece of the poem, the sudden emotional strike or impulse has shortly happened, which clearly shows the effect of the structure of Shathiyat:A tree with crazy branches
and the echo leaves
on the body of the mountain
The article of the protection of flowers in the garden (Royaee, 2008, p. 520).

The current study is based on a library study in which the authors refer to philosophical and literary books and take notes from them and analyze the information.

The current study studied the role of mysticism in the poetics of the image in Yadollah Royaee. It is concluded that mysticism had a mutual action in that poetry: one refers to the ethical dimension in mental education of spacement, reading, and writing and finds its roots in the effect from Husserl's phenomenology and the structure of the presence of the other. It should be noticed that this dimension of the role of mysticism cannot be achieved unless by passing through the first manifest of spacement poetry, the historical ideas of Yadollah Royaee, and the concentration on the second manifest of spacement poetry and its margins. The other action in texture and structure and the language of poem pieces finds its roots in the effect of mystical Shathiyat and objects the creation of some places with emotional impulses and a language affected by Shathiyat. Also, for the mystical and ethical capacities of "Labrikhteha" and "Hafted Sange Ghabr", the author has concentrated on these two poetic collections.

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.

Acute kidney injury (AKI) is a clinical syndrome in which the renal function deteriorates during a short period of time. It is usually accompanied by the accumulation of various waste products. Among the factors causing AKI, sepsis is considered the most important and common factor since about half of the patients diagnosed with AKI are also diagnosed with sepsis. Despite recent advances in medical science, AKI remains a challenge due in part to its importance and partly because of its prevalence in, especially, ICU settings.

Keeping in mind the importance of the issue and the lack of prior national data, the current study aimed to investigate the correlation of different factors with the occurrence of AKI in ICU-admitted patients diagnosed with sepsis.

In this retrospective study, a total of 65 adult patients admitted to the ICU were included and followed for a period of four weeks. The severity of AKI was determined using RIFLE scoring system, and the QSOFA score was calculated for the patients. Other factors such as creatinine level, CRP level, antibiotics received during the study period, and present comorbidities were also recorded. Finally, the correlation between these factors and the occurrence of AKI was determined.

AKI was found in 59 of the patients. Overall, cardiovascular diseases were the most common comorbidity, and Vancomycin and Carbapenem were the most widely used antibiotics. Among the factors investigated in this study, QSOFA score and Vancomycin were the only factors significantly correlated with AKI.

In sum, it was recommended that septic patients should be managed and provided with care based on their QSOFA scores as well as on the administration of Vancomycin and other nephrotoxic antibiotics.

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.