Association of TREX1 polymorphism with disease progression in human immunodeficiency virus type-1 (HIV-1) infected patients.

The time interval between HIV-1 infection and AIDS development is not the same in all patients and depends largely on the genetic background of the individual. Polymorphisms in the TREX1 gene, the main enzyme in the clearance of cytosolic DNA, affect type 1 interferon-mediated inflammatory response in HIV-1 infection. We aimed to study the role of a single nucleotide polymorphism (rs3135941) of the TREX1 gene and the rate of disease progression in patients infected with HIV-1. A total of 190 HIV-1 infected patients were recruited. Patients' demographic and laboratory data including CD4 counts, viral load, and antiretroviral therapy (ART) were collected. The genotype of rs3135941 was determined by a PCR-SSP method. The rate of progression to AIDS was calculated with Kaplan-Meier survival analysis using Stata software. The patients were divided into rapid and slow progressors based on time interval of CD4 drop below 350/µl. Kaplan-Meier analysis revealed an accelerated disease progression in patients with TC and CC genotypes (HR = 1.49, 95% CI = 1.01-2.17). The mean values of the first 5-year CD4 counts were significantly different in patients who had CC and TC genotypes compared to the TT group (p = 0.036). The result of this study emphasizes the importance of TREX1 polymorphism in HIV-1 progression. These data warrant further investigation into the role of other polymorphisms of TREX1.

"Struggle against Bitter Life": Lived Experience of Iranian Nurses with HIV/AIDS.

Objectives: The impact of HIV/AIDS on the healthcare system in many countries, particularly in developing countries is significant. Due to the high prevalence of HIV/AIDS in these countries, remarkable number of nurses have contracted HIV through their work. HIV/AIDS poses a major threat to people's physical and emotional health status as well as their social well-being and it has overwhelming effects on personal and social lives of HIV-positive people. HIV-positive nurses, like other patients, are subject to many stresses, but because of their special professional and social conditions they may bear more psychological and social burdens. Materials and methods: A hermeneutic phenomenological approach was used to examine the everyday experiences of nurses who suffer HIV/AIDS. To conduct the study, six methodical steps which developed by van Manen (1990) applied in the process of the inquiry. Eight HIV-positive nurses were recruited and selected through a purposive sampling method. Data was collected by conducting 12 face-to-face in-depth semi-structured interviews with participants, two women and six men who became HIV-infected through occupational exposure. A thematic analysis method was used to extract themes and sub-themes. Results:Through thematic analysis of transcriptions, two main themes 'past, not passed' and 'struggle against bitter life' emerged. We found that the daily life of HIV/AIDS nurses is like a limbo between the past and the present. They are constantly trying to push themselves from this limbo of death to life. Conclusion:According to the results, participants were immersed in bitter memories of their past, which has always cast a dark shadow over their lives. Their lived space surrounded by many bitterness and adversities, yet they have the enthusiasm to move on with their lives and struggle day-to-day to maintain their relative health and have their job as a nurse. As result, management of HIV/AIDS is not only about fighting the virus, but it imposes many issues and problems on nurses, which should be given more attention and support.

Tenofovir alafenamide plus dolutegravir as a switch strategy in HIV-infected patients: a pilot randomized controlled trial.

BACKGROUND: Currently, two-drug antiretroviral regimens are emerging fields in life-long treatment in people living with HIV. OBJECTIVES: This randomized non-inferiority open-label controlled trial was designed to compare the 48-week efficacy and safety of tenofovir alafenamide plus dolutegravir versus the standard triple therapy in virologically suppressed people living with HIV. To the best of our knowledge this combination has not been studied before. METHODS: This open-label randomized controlled trial was conducted in treatment-experienced people with HIV who had HIV-RNA < 47 copies/mL for at least two years. Patients received either tenofovir alafenamide plus dolutegravir combination (26 patients) or a standard three-drug regimen (29 patients). The primary outcome was the proportion of patients maintaining HIV-RNA < 47 copies/mL during 48 weeks, and the secondary outcomes were CD4 cell count changes, the adherence rate, and adverse drug reactions, all over 48 weeks of study. RESULTS: HIV viral load remained undetectable (HIV-RNA < 47 copies/mL) during the 48 weeks of the study in both arms. The absolute CD4 cell count change was not significant between the two groups. The overall proportion of adverse effects in each group was comparable. The rate of adherence to treatment was acceptable in both groups, and no significant difference was observed. CONCLUSIONS: Treatment simplification with tenofovir alafenamide plus dolutegravir regimen as maintenance therapy was non-inferior in terms of efficacy and safety compared to the standard triple therapy. Comparing efficacy of antiretroviral therapy.

Slight High-Frequency Hearing Loss, Effect of COVID-19 or Hydroxychloroquine Usage?

BACKGROUND AND OBJECTIVES: Concerns about ototoxic and vestibulotoxic effects have been raised with the use of antiviruses in the treatment of COVID-19. This study aimed to determine the effect of hydroxychloroquine (HCQ) and examine the auditory system and its associated auditory and vestibular symptoms in patients with COVID-19. STUDY DESIGN: Prospective study. PATIENTS: Thirty patients with a history of HCQ (HCQ+) and 30 patients without drug use (HCQ-), and 30 healthy adults as the control group participated. MAIN OUTCOME MEASURES: Audiological assessments and evaluation of audio-vestibular symptoms. Evaluations were also repeated 1 month later. RESULTS: Both HCQ+ and HCQ- groups showed poor pure-tone audiometry (PTA) thresholds and decreased transient evoked otoacoustic emission amplitudes at high frequencies in comparison to the healthy group. Despite the lack of significant differences in PTA between the two groups of patients, the differences in transient evoked otoacoustic emission amplitudes were significant. PTA thresholds and otoacoustic emission showed improvement after 1 month. Dizziness was the most common symptom that was reduced after 1 month. CONCLUSION: Slight hearing loss was seen in patients with COVID-19 with or without HCQ. Also, hearing thresholds in the HCQ+ group did not show a significant difference compared with the HCQ- group. Nevertheless, it seems that more damage is done to the hair cells of patients with HCQ intake than in other patients. Hence, the ototoxicity effect of high doses of HCQ use in the COVID-19 patients should be considered. A relative improvement in the hearing was seen over time in both patient groups.

Efficacy of a multiple-indication antiviral herbal drug (Saliravira®) for COVID-19 outpatients: A pre-clinical and randomized clinical trial study.

BACKGROUND: The scientific researches on COVID-19 pandemic topics are headed to an explosion of scientific literature. Despite these global efforts, the efficient treatment of patients is an in-progress challenge. Based on a meta-study of published shreds of evidence about compounds and their botanic sources in the last six decades, a novel multiple-indication herbal compound (Saliravira®) has been developed. Based on the antiviral, anti-inflammatory, and immune-enhancing properties of its ingredients, we hypothesized that Saliravira® has the potential to act as an antiviral agent, accelerate treatment, and reduce undesirable effects of COVID-19. METHODS: In this randomized, controlled, open-label clinical trial, COVID-19 outpatients were included by RT-PCR test or diagnosis of physicians according to the symptoms. Participants were randomly divided into intervention and control groups to receive Saliravira® package plus routine treatments of COVID-19 or routine treatments of COVID-19 alone, respectively. Saliravira® package includes tablets, nasal-sinuses spray, oral-pharynx spray, and inhaler drops. The treatment was for 10 days and followed up till 23 days after admission. RESULTS: On the 8th day, the "mean reduction rates" of viral load of the patients in the intervention group was 50% lower compared to the control group with a p-value < 0.05. The improvement of 10 out of 14 COVID-19 symptoms in the intervention group was significantly accelerated. The mean treatment duration of patients in the intervention group was 4.9 days less than the control group. In addition, no patients in the intervention group were hospitalized compared to 28% of the control group needed to be hospitalized.

Predictors of the chest CT score in COVID-19 patients: a cross-sectional study.

BACKGROUND: Since the COVID-19 outbreak, pulmonary involvement was one of the most significant concerns in assessing patients. In the current study, we evaluated patient's signs, symptoms, and laboratory data on the first visit to predict the severity of pulmonary involvement and their outcome regarding their initial findings. METHODS: All referred patients to the COVID-19 clinic of a tertiary referral university hospital were evaluated from April to August 2020. Four hundred seventy-eight COVID-19 patients with positive real-time reverse-transcriptase-polymerase chain reaction (RT-PCR) or highly suggestive symptoms with computed tomography (CT) imaging results with typical findings of COVID-19 were enrolled in the study. The clinical features, initial laboratory, CT findings, and short-term outcomes (ICU admission, mortality, length of hospitalization, and recovery time) were recorded. In addition, the severity of pulmonary involvement was assessed using a semi-quantitative scoring system (0-25). RESULTS: Among 478 participants in this study, 353 (73.6%) were admitted to the hospital, and 42 (8.7%) patients were admitted to the ICU. Myalgia (60.4%), fever (59.4%), and dyspnea (57.9%) were the most common symptoms of participants at the first visit. A review of chest CT scans showed that Ground Glass Opacity (GGO) (58.5%) and consolidation (20.7%) were the most patterns of lung lesions. Among initial clinical and laboratory findings, anosmia (P = 0.01), respiratory rate (RR) with a cut point of 25 (P = 0.001), C-reactive protein (CRP) with a cut point of 90 (P = 0.002), white Blood Cell (WBC) with a cut point of 10,000 (P = 0.009), and SpO2 with a cut point of 93 (P = 0.04) was associated with higher chest CT score. Lung involvement and consolidation lesions on chest CT scans were also associated with a more extended hospitalization and recovery period. CONCLUSIONS: Initial assessment of COVID-19 patients, including symptoms, vital signs, and routine laboratory tests, can predict the severity of lung involvement and unfavorable outcomes.

Prevalence of nosocomial infections in Covid-19 patients admitted to the intensive care unit of Imam Khomeini complex hospital in Tehran.

BACKGROUND AND OBJECTIVES: Nosocomial infections (NIs) are an important cause of mortality and morbidity in intensive care units (ICU). Pneumonia is the most common serious manifestation of infection in Covid-19 patients. The aim of this study was to investigate the prevalence of pneumonia in Covid-19 patients admitted to the ICU. MATERIALS AND METHODS: In this cross-sectional study, 1240 Covid-19 patients admitted for more than 48 h in the ICUs of Imam Khomeini Complex Hospital (IKCH) in Tehran for seven months in 2020 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 disk difusion method. RESULTS: In this study, 289 (23.3%) out of 1320 patients experienced NIs. 221 (76.4%) out of 289 patients had underlying diseases and the most common of which were hypertension, diabetes and heart disease, respectively. 163 patients (56.4%) were RT-PCR COVID-19 positive and 200 patients (69%) died. The majority of patients with NIs (71%) were over 55 years old. The most common type of nosocomial infection (66%) was ventilator-associated pneumonia (VAE). The most common microorganisms that cause pneumonia were Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa, respectively. CONCLUSION: Pneumonia infection is high in Covid-19 patients admitted to the ICU, it needs to be planned with the diagnosis and measures related to the control and prevention of this infection.

Effect of green tea consumption in treatment of mild to moderate depression in Iranian patients living with HIV: A double-blind randomized clinical trial.

Objective: Depression affects people living with HIV (PLWH) compliance leading to poor control infection. Previous observational studies showed an anti-depression effect of green tea extract (GTE). The therapeutic effect of GTE on depression were investigated in PLWH receiving antiretroviral therapy (ART). Methods: Fifty PLWH on ART with diagnose of mild to moderate of depression, participated in a double-blind, placebo-controlled trial and underwent 12 weeks of treatment with either 400 mg GTE capsules or placebo twice daily. The Hamilton depression scale of patients was measured before, 6 weeks and 12 weeks after treatment in two groups. The primary outcome measure was performed to evaluate the efficacy of GTE in improving depressive symptoms. Results: The mean of Hamilton score showed a significant difference between the two groups after 12 weeks (P = 0.035). Repeated measures ANOVA test showed a significant effect for time × treatment interaction on the Hamilton mean score between the two groups (P = 0.000). Conclusion: It seems the use of GTE capsules in PLWH on ART is safe and could lead to greater and more rapid improvement in depressive symptoms than placebo. Thus it can be considered as an alternative therapy for mild to moderate depression. Further studies with higher sample size and longer follow-up and comparisons with other antidepressive drugs are warranted.

Disseminated TB in an Immunocompetent Patient: A Case Report.

BACKGROUND: Tuberculosis considered as a chronic infectious disease caused by Mycobacterium tuberculosis, may invade all organs but mainly affects the lungs. Overall, disseminated TB is rare in immunocompetent patients and its association with seborrheic keratosis has never been reported. ; Case Presentation: We reported a 54-year-old man with a complaint prolonged fever, abdominal pain, weight loss and lymphadenopathy without any immunosuppression who was eventually treated based on the diagnosis of diffuse tuberculosis.

CT-scan findings of COVID-19 pneumonia based on the time elapsed from the beginning of symptoms to the CT imaging evaluation: a descriptive study in Iran.

Background. Coronavirus disease 2019 (COVID-19) was initially detected in Wuhan city, China. Chest CT features of COVID-19 pneumonia have been investigated mostly in China, and there is very little information available on the radiological findings occurring in other populations. In this study, we aimed to describe the characteristics of chest CT findings in confirmed cases of COVID-19 pneumonia in an Iranian population, based on a time classification.Methods. Eighty-nine patients with COVID-19 pneumonia, confirmed by a real-time RT-PCR test, who were admitted to non-ICU wards and underwent a chest CT scan were retrospectively enrolled. Descriptive evaluation of radiologic findings was performed using a classification based on the time interval between the initiation of the symptoms and chest CT-scan.Results. The median age of patients was 58.0 years, and the median time interval from the onset of symptoms to CT scan evaluation was 7 days. Most patients had bilateral (94.4%) and multifocal (91.0%) lung involvement with peripheral distribution (60.7%). Also, most patients showed involvement of all five lobes (77.5%). Ground-glass opacities (GGO) (84.3%) and mixed GGO with consolidation (80.9%) were the most common identified patterns. We also found that as the time interval between symptoms and CT scan evaluation increased, the predominant pattern changed from GGO to mixed pattern and then to elongated-containing and band-like-opacities-containing pattern; on the other hand, the percentage of lung involvement increased.Conclusions. Bilateral multifocal GGO, and mixed GGO with consolidation were the most common patterns of COVID-19 pneumonia in our study. However, these patterns might change according to the time interval from symptoms.

Hepatitis A Seroprevalence Among Patients with Chronic Hepatitis B Infection: A Cross-Sectional Study in Iran During 2016-2017.

INTRODUCTION: The aim of this study was to determine the prevalence of exposure to hepatitis A by means of serologic markers in chronic hepatitis B patients, with the secondary aim of finding the best prevention method for hepatitis A infection in susceptible groups of our setting. METHODS: During the period between 2016 and 2017, we recruited 403 hepatitis B patients aged more than 14 years and regularly attending the infectious diseases clinic at a referral university hospital, Tehran, Iran. A blood sample was collected from all the patients and tested for hepatitis A IgG. The data was analyzed by SPSS v.19. RESULTS: Although none of the patients had previously received hepatitis A vaccine, the results for serologic level of hepatitis A IgG, demonstrated positive results in 379 (94%) cases. The mean age of patients with negative and positive IgG was 29.17 and 42.46 years, respectively; the difference was statistically significant (P≤0.001). The majority of seronegative patients were young adults aged < 25 years and 25 to 35 years (P <0.001). CONCLUSION: Seroprevalence of hepatitis A in chronic HBV patients in Iran is high. As HBV infected patients younger than 35 years could be seronagative for HAV infection, evaluation of these patients for HAV infection and vaccination of seronegative patients would be a reasonable approach.

Endocarditis with Aeromonas salmonicida.

Aeromonas salmonicida (A. salmonicida) is a facultative Gram-negative bacillus, inhabiting in water. It is a common source of furunculosis and septicemia in fish. Report on the human infection with this organism is rare. A male farmer referred with weakness and intermittent fever. He had cardiac valves' regurgitation due to fever with rheumatic heart disease. He had a history of swimming in well water. Transthoracic echocardiography (TTE) revealed a mobile mass of 1.3 × 0.9 cm attached to the mitral valve chordae, suggestive of a vegetation. Aeromonas salmonicida was isolated from the blood. After cardiac surgery and taking ceftriaxone for 4 weeks, he was discharged in good general condition. Five previous case reports of human infection with this organism were found. The patient was the sixth human case, and the first endocarditis, reported with this organism. A. salmonicida is a rare agent for human infection. Contact with water is a risk factor for this type of infection. It seems that the use of modern diagnostic methods has been effective in identifying the microorganism.

Bilateral septic arthritis of the knee caused by group B streptococci: a case report.

Septic arthritis (SA) remains to be a critical diagnosis for a swollen knee at the emergency department. Here, we report a rare case of bilateral knee arthritis in a 59-year-old diabetic woman who had been immobilized 5 months prior to admission. Her right knee swelling exacerbated in 10 days leading to left knee involvement. In 5 days the clear synovial tap in the first hospital turned purulent in the second hospital and empirical antibiotics get started with high WBC count, dominant neutrophils, and Gram-positive cocci in smear. Knee arthrotomy was performed after 6 days in the third hospital with the same smear results but negative blood and synovial cultures of both knees. When followed in retrograde, two positive blood cultures were reported for Streptococcus agalactiae in the second hospital. Vancomycin was changed to ampicillin and symptoms were resolved in 4 weeks. Despite improvement, mobility was not retained. Uncommon etiologic agents of knee arthritis should be in mind specifically in debilitated patients. Timely initiation of proper antibiotics hinders permanent sequels, hence clinicians should be suspicious of such organisms.

Fatal cutaneous mucormycosis after kidney transplant.

Mucormycosis is an uncommon opportunistic infection that is caused by Mucorales from the Zygomycetes class. Patients with severe immunodeficiency admitted to the hospital are at greatest risk for developing this infection. Mucormycosis usually is transmitted in humans by inhalation or inoculation of spores in the skin or mucous membranes. A 66-year-old man developed a surgical wound infection at 1 week after kidney transplant that did not improve despite broad-spectrum antibiotics and debridement. He was transferred to our hospital 45 days after transplant and had fever and a large purulent wound that was surrounded by a black necrotizing margin. Immunosuppressive drugs were discontinued and the dosage of prednisolone was decreased. Massive debridement was performed but was incomplete because he had full-thickness abdominal wall necrosis. Histopathology showed broad fungal hyphae without septation, consistent with the diagnosis of mucormycosis. Despite antifungal therapy with amphotericin B and additional debridement, the patient died of septic shock at 52 days after kidney transplant. Cutaneous fungal infections should be considered in the differential diagnosis of any nonhealing infected wound that does not respond to broad-spectrum antibiotics, especially in patients with predisposing risk factors such as transplant.