Serum level of Vitamin D is associated with COVID-19 mortality rate in hospitalized patients.

BACKGROUND: Due to widespread of coronavirus disease 2019 (COVID-19) infection, identification of its risk factors and clinical characteristics are important. The aim of the present study was to assess Vitamin D levels in individuals with severe acute respiratory syndrome coronavirus-19 infection and to report on its potential as a predictive marker. MATERIALS AND METHODS: All patients, diagnosed with COVID-19 infection from February 16 to March 21, 2020, and referred to Firoozgar Hospital, Tehran, Iran, were enrolled in this study. Vitamin D analysis was undertaken on patient serum samples using a commercial kit (Pars Azmoon Co., Tehran, Iran). SPSS v. 22 was used for statistical analysis. RESULTS: Vitamin D serum concentration was analyzed in a total of 317 patients whose mean age ± standard deviation was 62.05 ± 15 years and with 62.5% being male. A significant association of Vitamin D level and death was observed. Higher levels of serum Vitamin D had protection against death (odds ratio = 0.955 [95% confidence interval = 0.923-0.988], P = 0.008). CONCLUSION: As a preliminary study in the Iranian population who suffered COVID-19 disease, we identified that Vitamin D deficiency was associated with a higher death rate and intensive care unit admission.

Effect of Arbidol (Umifenovir) on COVID-19: a randomized controlled trial.

BACKGROUND: Treatment of patients with COVID-19 has included supportive care to mainly relief symptoms of the disease. Although World Health Organization (WHO) has not recommended any effective treatments for COVID-19, there are some reports about use of antiviral drugs. The aim of this study is to determine the effect of Arbidol (ARB) on COVID-19 disease. METHODS: Using an open-label randomized controlled trial, we examined the efficacy of ARB in patients with COVID-19 in a teaching hospital. One hundred eligible patients with diagnosis of COVID-19 were recruited in the study and assigned randomly to two groups of either hydroxychloroquine followed by KALETRA (Lopinavir/ritonavir) or hydroxychloroquine followed by ARB. The primary outcome was hospitalization duration and clinical improvement 7 days after admission. The criteria of improvement were relief of cough, dyspnea, and fever. Time to relief from fever was also assessed across the two groups. Without any dropouts, 100 patients were entered into the study for the final analysis at significance level of 0.05. RESULTS: The mean age of patients was 56.6 (17.8) years and 56.2 (14.8) years in ARB and KALETRA groups, respectively. Majority of patients were male across two groups (66 and 54%). The duration of hospitalization in ARB group was significantly less than KALETRA arm (7.2 versus 9.6 days; P = 0.02). Time to relief fever was almost similar across two groups (2.7 versus 3.1 days in ARB and KALETRA arms, respectively). Peripheral oxygen saturation rate was significantly different after 7 days of admission across two groups (94% versus 92% in ARB and KALETRA groups respectively) (P = 0.02). Based on multiple linear regression analysis, IHD, Na level, and oxygen saturation at the time of admission and type of therapy were the independent adjusted variables that determined the duration of hospitalization in patients with COVID-19. CONCLUSION: Our findings showed that Arbidol, compared to KALETRA, significantly contributes to clinical and laboratory improvements, including peripheral oxygen saturation, requiring ICU admissions, duration of hospitalization, chest CT involvements, WBC, and ESR. We suggest further studies on ARB against COVID-19 using larger sample size and multicenter design. TRIAL REGISTRATION: IRCT20180725040596N2 on 18 April 2020.

Biological evidence of the relationship between Helicobacter pylori and associated extragastric diseases.

BACKGROUND: Gram-negative bacterium, Helicobacter pylori is notorious for various pathologies like peptic ulcers, gastritis, functional dyspepsia, and various cancers. METHODS: Systemic effects of its toxins have led scientists' attention toward the extragastric pathologies associated with it. To date, it has been shown to have an effect on almost all the systems in the human body. RESULTS: Various studies have been conducted to obtain the relation between H. pylori infection, and other diseases. CONCLUSION: In this review, we aim to discuss the extragastric diseases associated with H. pylori and the biological factors that relate them to it.

Topical Treatment of Second-Degree Burn Wounds with Lactobacillus plantarum Supernatant: Phase I Trial.

Background & Objective: A burn wound is sterile immediately after injury, but opportunistic bacteria colonize the wound within 48 to 72 hours after the burn, causing delayed or failed burn wound healing. In addition, the presence of multidrug-resistant (MDR) pathogens doubles the treatment problems. Lactobacillus plantarum (L. plantarum) is a well-known antibacterial and healing agent that could be used topically to treat burn wounds. Case Series Presentation: This clinical trial study (Case Series) was performed on 20 patients with deep second-degree burns. Patients had bilateral wounds; the wound on one side of the body was considered as control (treated with silver sulfadiazine) and the other side of the body as treatment (treated with bacteria-free supernatants (BFS) of L. plantarum). The wounds were evaluated by microbial assessments and assessments related to healing. Pseudomonas aeruginosa, Klebsiella pneumonia, and Staphylococcus aureus were isolated from 4 (22.2%), 0%, and 2 (11.1%) of wounds treated with L. plantarum on the fifth day of the treatment, respectively. Furthermore, 12 (66.7%) of wounds treated with L. plantarum were free from bacteria. The need for skin grafting was the same in both treatment and control groups, but graft rejection in the group treated with L. plantarum was (0%) (P=0.02). Conclusion: Regarding eliminating or reducing infection and wound healing, bacteria-free supernatants of L. plantarum can be considered a possible topical treatment option in the case of second-degree burn wounds.

Association of coronavirus pathogencity with the level of antioxidants and immune system.

Viruses are non-living organisms that annually cause many problems for human societies. The spread of some of the most dangerous viruses causing acute pneumonia, including novel Corona virus has led to the largest death toll in the world. With a long incubation period, Corona virus causes many problems for the immune system. Studies have shown that antioxidant enzymes play an important role in reducing infection and boosting the immune system. The immune system of people with chronic infections is often weak. Specific immunity is one of the most important responses to the virus. The present study therefore investigates association of Coronavirus pathogenicity with the level of antioxidants and immune system.

Infliximab and Intravenous Gammaglobulin in Hospitalized Severe COVID-19 Patients in Intensive Care Unit.

BACKGROUND: Severe coronavirus disease 2019 (COVID-19) may lead to the cytokine storm syndrome which may cause acute respiratory failure syndrome and death. Our aim was to investigate the therapeutic effects of infliximab, intravenous gammaglobulin (IVIg) or combination therapy in patients with severe COVID-19 disease admitted to the intensive care unit (ICU). METHODS: In this observational research, we studied 104 intubated adult patients with severe COVID-19 infection (based on clinical symptoms, and radiographic or CT scan parameters) who were admitted to the ICU of a multispecialty hospital during March 2020 in Tehran, Iran. All cases received standard treatment regimens as local protocol (Oseltamivir + hydroxychloroquine + lopinavir/ritonavir or sofosbuvir or atazanavir ± ribavirin). The cases were grouped as controls (n = 43), infliximab (n = 27), IVIg (n = 23) and combination (n = 11). RESULTS: There was no significant difference between controls and treatment groups in terms of underlying diseases or the number of underlying diseases. The mean age (SD) of cases was 72.42 (16.06) in the control group, 64.52 (12.965) in IVIg, 63.40 (17.57) in infliximab and 64.00 (11.679) in combination therapy; (P = 0.047, 0.031 and 0.11, respectively). Also, 37% in the infliximab group, 26.1% in IVIg, 45.5% in combination therapy, and 62.8% in the control group expired (all P < 0.05). Hazard ratios were 0.31 in IVIg (95% CI: 0.12-0.76, P = 0.01), 0.30 in infliximab (95% CI: 0.13-0.67, P = 0.004), 0.39 in combination therapy (95% CI: 0.12-1.09, P = 0.071). CONCLUSION: According to the findings of this study, it seems that infliximab and IVIg, alone or together, in patients with severe COVID-19 disease can be considered an effective treatment.

Role of Helicobacter pylori infection in the manifestation of old age-related diseases.

Helicobacter pylori is one of the most prevalent infection worldwide. It affects individuals of different age groups. Elderly people tend to resist eradication treatment and worsening of infection can lead to several gastric and non-gastric pathologies. Aging-associated cellular and molecular alteration can increase the risk of other pathologies such as osteoporosis, Alzheimer's disease, Parkinson's disease, respiratory and renal dysfunction, and cancer in geriatric patients, more than other age groups. This review article highlights some of the most common old age diseases and the role of H. pylori infection as a risk factor to worsen the conditions, presented by the molecular evidences of these associations. These studies can help clinicians to understand the underlying pathogenesis of the disease and identify high-risk patients, aiding clearer diagnosis and treatment.

Comparative effects of granulocyte-colony stimulating factor and colistin-alone or in combination on burn wound healing in Acinetobacter baumannii infected mice.

BACKGROUND AND OBJECTIVES: Burn wounds are one of the most important health problems all over the world because infection after burn can delay wound healing. Treating burn wounds with granulocyte-colony stimulating factor (G-CSF) is known to improve healing of injured tissue. In addition, colistin is prescribed as an effective treatment. The aim of this study was to evaluate the effect of G-CSF and colistin alone or in combination with G-CSF on wound healing of Acinetobacter baumannii (A. baumannii) infected burns. MATERIALS AND METHODS: This study was performed between January 2016 and April 2018. Burn wounds were experimentally induced in 36 mice. The wounds were inoculated with A. baumannii. In a 7-day period, burn wounds in each group were daily treated with subcutaneous injections (0.1 ml) of saline, G-CSF, colistin, and G-CSF plus colistin. After killing the animals, the size of the wound, number of leukocytes in the skin and microbial growth were evaluated. A value of p ≤ 0.05 was considered statistically significant. RESULTS: Wound healing in the G-CSF plus colistin group was significantly higher than the control group and the G-CSF group (P = 0.023 and P = 0.033, respectively). In G-CSF+colistin group, the number of leukocytes was higher than the control group considerably (P = 0.007). On the 7th day of treatment, number of positive bacterial cultures in the colistin and the G-CSF plus colistin groups was lower than other groups with a significant difference. CONCLUSION: Concurrent consumption of G-CSF and antibiotics can control burn infection and enhance the immune system towards wound healing.

Epidemiologic analysis of central vein catheter infection in burn patients.

BACKGROUND AND OBJECTIVES: Currently, there are no well-defined guidelines or criteria for catheter-site care in burn patients, and there is little information about the epidemiology of central vein catheter (CVC) infection in such patients. This study aimed at addressing the epidemiological aspect of CVC infection in a sample of Iranian burn patients admitted to the largest referral burn center in Iran, Motahari Burn Center. MATERIALS AND METHODS: A total of 191 burn patients were eligible for the study. Catheter related blood stream infection (CRBSI) was diagnosed according to suspected line infection, sepsis or blood culture growing bacteria, which could not have been associated with another site. RESULTS: Of the 191 patients in this study, 45 males (23.68%) and 19 females (10%) had positive blood culture, confirming CV line infection. Patients who were burned by gas, gasoline ignition or burning Kerosene had the highest incidence of CV line infection. In contrast, patients burned by alcohol, pitch or thinner had the lower rate of CV line infection. Incidence of CV line infection was higher in patients with delay in presentation to the burn center (55.2%) when compared to those who presented without delay (22.8%). Pseudomonas aeruginosa was the most frequent colonizer of the wound culture (52.4%), the dominant strain of the first catheter tip culture (35%) and the dominant strain of the same day blood samples (53.8%). The mortality rate in patients diagnosed with CRBI was 21.9%. CONCLUSION: One of the important factors related to CV line infection is delay inpresentation to the burn center. The rate of CV line infection was 20.64 in catheter days.

The seroprevalence of Mycoplasma pneumoniae IgM and IgG antibodies in patients with ischemic stroke.

BACKGROUND AND OBJECTIVES: Association between Mycoplasma pneumoniae infection and increased risk for brain stroke has been well understood. Hence, the value of serologic tests for assessing causative relationship between this infection and brain stroke seems to be high. The present study aimed to determine serum level of anti-Mycoplasma pneumoniae antibodies in patients with brain stroke and to compare it with non-stroke patients. MATERIALS AND METHODS: This cross-sectional study was performed on 97 consecutive ischemic stroke patients and 97 sex and age-matched non-stroke patients. Quantitative enzyme-linked immunosorbent assay (ELISA) was established to measure the levels of anti-Mycoplasma pneumoniae IgG and IgM antibodies. RESULTS: Regarding the level of anti-Mycoplasma pneumoniae IgM, the titer of this marker was positive in 4.1% of patients with ischemic stroke, while none of the subjects in control group had positive titer for this antibody (OR = 1.043, 95%CI: 1.001 - 1.087, p = 0.043). The rate of positivity for anti-Mycoplasma pneumoniae IgG in ischemic stroke patients was significantly higher than in the control group (28.5% versus 13.4%, p = 0.031). Odds ratio for exposure to M. pneumoniae was 2.24 times of the control subjects. The level of anti-Mycoplasma pneumoniae IgM was independent to both sex and age variables in patients group (p = 0.77). The level of anti-Mycoplasma pneumoniae IgG did not depend on subjects' gender in control group, but was significantly higher in men compared with women in patients group. CONCLUSION: A high level of anti-Mycoplasma pneumoniae IgM and IgG antibodies indicate a significant association of M. pneumoniae infection and history of this infection with increased risk for ischemic stroke.

Pleural and pericardial effusions: rare presentations of brucellosis, Iran.

We report a rare case of brucellosis presenting with pleural and pericardial effusions in a 35 year-old male rancher in Iran with fever and dyspnea. Such findings should prompt inclusion of brucellosis in the differential diagnosis in endemic areas.

Respiratory Complications in Iranian Hospitalized Patients with HIV/AIDS.

BACKGROUND: The respiratory tract has been the most commonly affected site of illness in HIV-infected patients. The current study was done to identify the frequency of respiratory complications in a consecutive case series of HIV-positive patients in Iran. MATERIALS AND METHODS: This study was a retrospective analysis at the national academic reference medical center of Imam-Khomeini Hospital, in Tehran, Iran. The study included 199 new admissions for 177 HIV-infected patients between 2000 and 2005. Demographic characteristics, risk factors for HIV infection, respiratory complications, and CD4+ lymphocyte counts were evaluated in these patients. RESULTS: All patients were males. The mean age was 35 years (age range: 15 to 63 years). Among 34 cases with available CD4+ lymphocyte count results, 70.6% had results <200 cells/mm(3). Nearly half the patients (47.7%) had respiratory symptoms. The most common pulmonary complications were cough (86.3%), sputum (71.6%), dyspnea (54.7%), and hemoptysis (10.5%). The most common diagnosis was pulmonary tuberculosis (27.1%), followed by other bacterial pneumonias (16.6%) and pneumocystis carinii pneumonia (4.5%). Intravenous drug users who had history of incarceration had the highest risk factors for Mycobacterium tuberculosis infection (59%), and other bacterial pneumonias (52%). CONCLUSION: Our study demonstrates that respiratory complications are highly frequent in HIV patients in Iran and that pulmonary tuberculosis is still a common complication in HIV infected patients, despite the availability of effective treatment. Results suggest the need for more effective preventive and prophylactic measures, wider use of antiretroviral treatment and effective chemotherapy for Iranian patients with HIV/AIDS.

Afferent modulation of neonatal rat respiratory rhythm in vitro: cellular and synaptic mechanisms.

In mammals, expiration is lengthened by mid-expiratory lung inflation (Breuer-Hering Expiratory reflex; BHE). The central pathway mediating the BHE is paucisynaptic, converging on neurones in the rostral ventrolateral medulla. An in vitro neonatal rat brainstem-lung preparation in which mid-expiratory inflation lengthens expiration was used to study afferent modulation of respiratory neurone activity. Recordings were made from respiratory neurones in or near the pre-Bötzinger Complex (preBötC). Respiratory neurone membrane properties and BHE-induced changes in activity were characterized. Our findings suggest the following mechanisms for the BHE: (i) lung afferent signals strongly excite biphasic neurones that convey these signals to respiratory neurones in ventrolateral medulla; (ii) expiratory lengthening is mediated by inhibition of rhythmogenic and (pre)motoneuronal networks; and (iii) pre-inspiratory (Pre-I) neurones, some of which project to abdominal expiratory motoneurones, are excited during the BHE. These findings are qualitatively similar to studies of the BHE in vivo. Where there are differences, they can largely be accounted for by developmental changes and experimental conditions.