Epidemiological features, antimicrobial resistance profile and clinical outcomes of healthcare-associated infections in Islamic Republic of Iran.

Background: Healthcare-associated infections are a major cause of mortality worldwide, especially in intensive care units where severely ill patients have limited physical space. Aims: To investigate the incidence, microbial aetiology, antimicrobial resistance profile, and mortality rate of healthcare-associated infections in intensive care units in the Islamic Republic of Iran. Methods: This observational study retrospectively reviewed the medical records of 1722 intensive care units patients with confirmed healthcare-associated infections at hospitals affiliated with Mashhad University of Medical Sciences in 2017-2019. Data was analysed using SPSS for Windows version 11. Categorical variables were described using frequency and percentage, whereas continuous variables were defined using mean (standard deviation) with 95% confidence interval (CI) for precision. Logistic regression analysis was used to estimate crude odds ratio (OR) and adjusted OR (AOR) with 95% CI, and to identify univariate and multivariate predictors of healthcare-associated infection mortality. Results: In total, 4077 pathogens were isolated, yielding a healthcare-associated infection incidence rate of 22.1%. The most common microorganisms were Acinetobacter spp. (25.0%), Klebsiella spp. (15.1%), Staphylococcus spp. (14.0%), and Candida spp. (12.3%). Ventilator-associated events (39.5%), urinary tract infections (22.7%), and bloodstream infections (14.8%) were the main types of infection. Comorbidities, skin and soft tissue infections, and infections with Acinetobacter spp., Klebsiella spp., Pseudomonas spp., and Candida spp. were significantly associated with higher mortality among intensive care unit patients. Gram-positive bacteria were most resistant to ciprofloxacin (49.2%), clindamycin (38.0%), and erythromycin (37.1%). Gram-negative bacteria were most resistant to ceftazidime (71.0%), ciprofloxacin (65.2%), and cefotaxime (60.5%). The overall mortality rate was 45.2%. Conclusion: Healthcare-associated infections in nearly half of intensive care unit patients were fatal, especially when caused by Acinetobacter spp., Klebsiella spp., Pseudomonas spp., or Candida spp. Therefore, effective strategies must be implemented to combat antibiotic-resistant bacteria, along with stricter adherence to infection control programmes.

Mucormycosis in pre-COVID-19 and COVID-19 era: A study of prevalence, risk factors and clinical features.

Objective: Mucormycosis is a rare yet devastating fungal disease with a frequently fatal outcome. The purpose of this study was to compare the prevalence of mucormycosis, evaluate its risk factors, and assess the patients' outcomes in pre-COVID-19 and COVID-19 era. Methods: In this retrospective observational study, clinical data of 158 patients with confirmed histopathological diagnosis of mucormycosis were collected from the medical records departments of Imam Reza and Ghaem hospitals, Mashhad, Iran during 2018-2021. The collected data were risk factors associated with mucormycosis including age, gender, underlying diseases, details of corticosteroid administration, and complications such as blindness and mortality. Results: Of 158 studied patients, 48 patients were diagnosed in the pre-pandemic period whereas 110 cases were admitted during the pandemic era. COVID-19 associated mucormycosis (CAM) was observed in 58.1% of the pandemic cases. In the pre-pandemic period, cancer (89.5% vs. 39%, p < .001) was significantly more prevalent while during the pandemic era, the prevalence of diabetes mellitus (16.7% vs. 51%, p < .001) was remarkably higher. Moreover, the mortality rate of mucormycosis was considerably reduced after the pandemic (64.6%-45.4%), especially in CAM patients (35.9%). Conclusion: The COVID-19 pandemic has led to an increased prevalence of mucormycosis, due to the convergence of interlinked risk factors such as diabetes mellitus, corticosteroid therapy, and COVID-19. Therefore, clinicians must be aware of the probable occurrence of mucormycosis in the first or second week of COVID-19 infection in vulnerable patients and use the steroids cautiously. Level of evidence: 4 Laryngoscope Investigative Otolaryngology, 2022.

The effect of glucagon-like peptide-1 receptor agonists on serum uric acid concentration: A systematic review and meta-analysis.

AIMS: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a class of medications mainly used for the treatment of type 2 diabetes. They improve glucose tolerance, increase insulin secretion and induce weight loss. There is controversy about the effect of GLP-1 RAs on serum uric acid (SUA) concentration. Our systematic review aims to objectively answer whether GLP-1 RAs affect SUA levels. METHODS: We performed a systematic search on PubMed, Web of Science, Embase, Scopus and Google Scholar datasets up to 27August 2021 with a language restriction of English only. Randomized controlled trials, observational studies, uncontrolled trials and conference abstracts were included. Studies with insufficient data, irrelevant types of study and follow-up duration of less than a month were excluded from the review. After critical appraisal by the Joanna Briggs Institute checklists, articles underwent data extraction using a prespecified Microsoft Excel sheet. RESULTS: Of 1004 identified studies, 17 were eligible for inclusion in this systematic review. Pre- to post-administration analysis of GLP-1 RA effects on SUA demonstrated that GLP-1 RAs could significantly reduce SUA concentration (difference in means -0.341, SE 0.063, P value <0.001). However, when compared to placebo, GLP-1RAs did not perform any better in lowering SUA concentration (difference in means -0.455, SE 0.259, P value 0.079). Surprisingly, the active controls, which included insulin, metformin, sodium-glucose co-transporter 2 (SGLT-2) inhibitors and dipeptidyl-peptidase 4 inhibitors, did outperform GLP-1 RAs in reducing SUA concentration (difference in means 0.250, SE 0.038, P value <0.001). CONCLUSIONS: Administration of GLP-1 RAs can result in a significant reduction in SUA concentration. However, this reduction is less than that seen with the use of insulin, metformin and SGLT-2 inhibitors.

Extensive bilateral diffuse infiltrates and deterioration of lung following infection with severe acute respiratory syndrome coronavirus 2 in a pregnant woman: a case report.

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 is the third member of the coronavirus family to cause global concern in the twenty-first century. Pregnant women are particularly at higher risk of developing severe viral pneumonia, possibly because of a partial immune suppression during their pregnancy. Under such critical and rapidly evolving circumstances, these poor findings might be helpful for the treatment of infected pregnant women with the 2019 novel coronavirus. CASE PRESENTATION: In this study, we report the case of a 33-year-old Asian pregnant woman at 25 gestational weeks with coronavirus disease 2019 who developed severe complications, including hypoxemia, acute respiratory distress syndrome, pulmonary infiltration, and bilateral pleural effusion. She died 1 month after admission to the hospital. CONCLUSION: Pregnant populations are especially at higher risk of viral pneumonia development caused by severe acute respiratory syndrome coronavirus 2. Further research on the prevention and treatment of the new coronavirus is necessary.

Neonates with coronavirus disease 2019 acquired from infected mothers: the incompatibility of maternal intensity and infant lung involvement: two case reports.

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared a public health emergency by the World Health Organization on January 30, 2020. The results of recent studies have suggested that neonates may present symptoms of COVID-19. Although the presentation of the disease in neonates is known to vary, only a limited number of studies have investigated newborns infected with COVID-19. CASE PRESENTATION: This study presents two Asian cases of newborns with COVID-19. Maternal-fetal or postnatal transmission was suggested based on the simultaneity of maternal infection. Chest radiography in one of the neonates showed severe lung involvement. Despite support and resuscitation attempts, the poor clinical condition of the neonate led to his death. However, the two mothers and one of the neonates were discharged from the hospital in good general condition. CONCLUSION: The neonates had worse clinical conditions than the mothers, and the intensity of pneumonia and level of lung involvement in the newborns were not associated with the stage and severity of the disease in the mothers with COVID-19.

Abobotulinum toxin A for periorbital facial rejuvenation: impact on ocular refractive parameters.

CLINICAL RELEVANCE: Botulinum toxin is commonly used for cosmetic facial rejuvenation and can result in pain at the injected site, bruising and ecchymosis, erythema and oedema, headache, diplopia, blurred vision, focal facial weakness. This study evaluates the impact of botulinum toxin on refractive error and binocular vision. BACKGROUND: Botulinum toxin (trade name: Dysport) is a neurotoxic protein which is made from a Gram-positive anaerobic bacterium known as Clostridium botulinum. In this study, we aimed to evaluate the impact of Dysport injection on refractive error, near point of accommodation and convergence, and palpebral fissure height. METHODS: Twenty-eight subjects were treated for facial wrinkles, using Dysport. A 500-unit vial of Dysport was diluted with 2.5-ml preserved normal saline, and injected doses were 30-units for crow's feet, six units for lower eyelid wrinkles, 25 to 50-units for glabellar lines (five points), and 20 to 40 for forehead creases on four points. The refractive error, near point of accommodation and convergence and palpebral fissure heights were assessed before and two weeks after injection. RESULTS: The participants comprised 23 women and five men at a mean age of 53.51 ± 14.1-years. The means of the equivalent sphere before and after injection were -0.07 ± 1.34 and -0.08 ± 1.35 (p = 0.36). The means of near point of accommodation monocularly before and after injection were 29.75 ± 6.16-cm and 26.75 ± 6.00, respectively. The means of near point of convergence before and after injection were 16.03 ± 5.27-cm and 15.55 ± 6.14, respectively (p = 0.30). The means of palpebral fissure height before and after injection were 10.33 ± 1.69-mm and 10.20 ± 1.46-mm, respectively. The changes in equivalent spherical refractive error, binocular near point of accommodation and convergence were not statistically significant. CONCLUSION: Dysport injection for the correction of upper face animation lines, if performed at the appropriate sites and the appropriate concentration, has no significant impact on refractive error, near point of accommodation and convergence, and palpebral fissure height.

The enzymes and electrolytes profiles in sera of Iranian stray dogs naturally infected with Neospora caninum

The protozoan Neospora caninum (Apicomplexa: Sarcocystidae), respectively infects canids and ruminants as the most definitive and intermediate hosts. A diagnosis of neosporosis is generally made on the basis of clinical signs together with the detection of high levels of antibodies in serum. The present study compares the serum electrolyte profile (Ca, K, Mg, Na, P) and serum enzyme level (ALP, AST, CPK) of non-infected dogs with those of stray dogs naturally infected with N. caninum. The indirect fluorescent antibody test (IFAT) revealed that 17 of the 137 analysed serum samples (12.41%) of the stray dogs were seropositive (Sp) to N. caninum. Serum levels of the electrolytes and the enzymes were evaluated in the 17 Sp and 28 seronegative (Sn, 20.44%) dogs using common enzyme kits, spectrophotometry and flame photometry techniques. The average serum level of ALP, AST, and CPK were found to be significantly higher in the Sp stray dogs. Measurements of the average serum levels of Ca, K, Mg, and P were higher in Sp than Sn stray dogs, with the average K level being significantly higher in seropositive stray dogs. It was concluded that evaluation of serum enzyme and electrolyte levels may be used to screen N. caninum infection in stray dogs.