Pathogenesis of COVID-19; Acute Auto-inflammatory Disease (Endotheliopathica & Leukocytoclastica COVIDicus).

BACKGROUND: The pathogenesis of the COVID19 pandemic, that has killed one million nine hundred people and infected more the 90 million until end of 2020, has been studied by many researchers. Here, we try to explain its biological behavior based on our recent autopsy information and review of literature. METHODS: In this study, patients with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) result were considered eligible for enrollment. Histopathological examinations were done on 13 people who were hospitalized in Afzalipour hospital, Kerman, Iran. Clinical and laboratory data were reviewed. Tissue examination was done by light microscopy, immunohistochemistry and electron microscopy. RESULTS: The most frequent co-morbidity in the patients was cardiovascular disease. The common initial symptoms of COVID-19 infection were dyspnea and cough. In all cases, the number of white blood cells was higher than the normal range. Common histopathological findings were variable degrees of vasculitis as degenerative to necrotic changes of endothelium and trafficking of inflammatory cells in the vessel wall with fibrinoid necrosis. Tissue damage included interstitial acute inflammatory cells reaction with degenerative to necrotic changes of the parenchymal cells. CD34 and Factor VIII immunohistochemistry staining showed endothelial cell degeneration to necrosis at the vessel wall and infiltration by inflammatory cells. Electron microscopic features confirmed the degenerative damages in the endothelial cells. CONCLUSION: Our histopathological studies suggest that the main focus of the viral damage is the endothelial cells (endotheliopathica) in involved organs. Also, our findings suggest that degeneration of leukocytes occurs at the site of inflammation and release of cytokines (leukocytoclastica) resulting in a cytokine storm.

Prevalence of methicillin-resistant Staphylococcus aureus in Iranian children: a systematic review and meta-analysis.

BACKGROUND: Antibiotic resistance is associated with longer hospitalizations, higher treatment costs, and increased morbidity and mortality rates. PURPOSE: This study aimed to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in Iranian children. METHODS: International databases, including Web of Science, PubMed, Embase, and Scopus, and Iranian databases, including Scientific Information Database (www.sid.ir), Magiran, and Iranian Database for Medical Literature (idml.research.ac.ir), were systematically searched for articles published between January 2000 and August 2019. Sources of heterogeneity were determined using subgroup analysis and meta-regression. RESULTS: Overall, 343 studies were identified; of them, 20 were included in the meta-analysis to estimate the pooled prevalence. The pooled prevalence of MRSA was 42% (95% confidence interval [CI], 29-55) among culture-positive cases of S. aureus, 51% (95% CI, 39-62) in hospitalized children, and 14% (95% CI, 0.05-27) in healthy children. CONCLUSION: The overall pooled prevalence of MRSA in children was 42%. Appropriate infection control measures and effective antibiotic therapy are needed.

Comparing the Efficacy of Methadone and Tincture of Opium in Controlling Agitation Caused by Withdrawal Syndrome in Opium-Addicted Patients in the Intensive Care Unit: A Randomized Trial Study.

BACKGROUND: Few studies have been conducted regarding the comparison of the efficacy of methadone and tincture of opium (TOP) in controlling agitation induced by withdrawal syndrome. Therefore, the current randomized trial study is carried out with the aim to evaluate comparisons on the efficacy of methadone and TOP in controlling agitation caused by withdrawal syndrome in opium addicted patients in the intensive care units (ICUs). METHODS: This clinical trial study was conducted on 60 patients admitted to ICU of Shahid Bahonar Hospital, Kerman, Iran. After classification of the patients into two groups, the first and second groups consumed methadone syrup (5 mg/ml) and TOP (10 mg/ml), respectively. Agitation in these patients was assessed through the Richmond Agitation-Sedation Scale (RASS). Vital signs were also assessed. Paired sample t-test and independent t-test were used for data analysis. FINDINGS: In the current study, the administered dose of methadone and TOP was 36.17 ± 26.99 and 112.67 ± 102.74 mg, respectively (P < 0.010). Methadone administration led to a significant decrease of the patients' vital signs, including systolic blood pressure, heart rate, respiratory rate, and Glasgow Coma Scale (GCS) (P < 0.05). Though TOP administration decreased systolic blood pressure and GCS significantly (P < 0.05), it had no effect on patients' diastolic blood pressure, body temperature, heart rate, and respiratory rate (P > 0.05). In total, no significant difference was detected between two groups regarding vital signs (P > 0.05). However, a significant difference was seen between methadone and TOP groups in terms of RASS score (P < 0.01). CONCLUSION: According to the results of the current study, lower dose of methadone, compared to TOP, could control agitation caused by opium withdrawal symptoms.

Evaluation of Bactereuria and Antimicrobial Susceptibility among Hospitalized Patients With and Without Catheter in Kerman Province- Iran in 2011.

Nearly 15% to 25% of patients in general hospitals have a catheter at some time during their stay. Up to 97% of nosocomial urinary tract infections (UTIs) are related to catheter. The type of bacteremia is usually polymicrobial which makes the treatment more difficult. Previous studies showed an increase in mortality from bacteremia in these patients. The aim of the present study was to compare the prevalence of UTIs among patients with and without catheter, and to detect the type of bacteriuria and antibacterial resistance pattern. In this cross sectional study, samples were taken between Jan 2011 and July 2011. 678 hospitalized patients in different wards of Afzalipour hospital, Kerman- Iran, were enrolled in the study. E-test was applied to detect the pattern of resistance to gentamicin, nitrofurantoin, ciprofloxacin, ceftriaxon and co-trimoxazole. Results showed positive culture samples in 86% of female patients. Escherichia coli, Candida and Staphylococcus aureus were detected in 72, 20 and 7 percent of the positive cultures, respectively. 52.3% of detected E.coli was sensitive to gentamicin , 62% to ceftriaxone, 71.4% to ciprofloxacin, and 91.9% were sensitive to nitrofurantoin. Therefore, the most sensitive antibiotics in UTIs were ciprofloxacin and ceftriaxone. Unfortunately, the rate of antibacterial drug resistance was high in comparison with developed countries. Wise selection of antibiotics at hospitals and increasing the knowledge of patients to prevent self use of antibiotics can reduce antimicrobial resistance.

Hyponatremia due to pulmonary tuberculosis: review of 200 cases.

BACKGROUND: Pulmonary Tuberculosis (PTB) is one of the common diseases with high prevalence of mortality and morbidity in developing countries. Various complications have been reported along with PTB. The subclinical electrolyte imbalances are customary in cases with PTB. OBJECTIVES: The aim of this study was the evaluation of patients with PTB and hyponatremia. PATIENTS AND METHODS: We evaluated patients with diagnosis of secondary PTB who have been admitted to Baqiyatallah hospital, Tehran, Iran from 2005 till 2010. The diagnosis of PTB was based on the appearance of acid fast bacilli in sputum smears or sputum cultures, without any evidence of miliary TB. Demographic and laboratory characteristics relative to electrolytes were recorded according inclusion and exclusion criteria. RESULTS: The mean age was 59.22 ± 20.57 years and 91 (45.5%) patients were male. The mean serum sodium concentration was 134.54 ± 4.95 mmol/L and more than half of subjects (51%) have shown hyponatremia. The mean age difference between hyponatremic and eunatremic groups was statistically significant (61.95 versus 56.02 years) (P = 0.047). No significant relationship was found between hyponatremia and gender, anti-TB medications and co-morbidity conditions. CONCLUSIONS: In this study, an older age was suggested as an important predisposing factor for hyponatremia in patients with PTB which had been observed as less of a determinant. We recommend further evaluations for hyponatremia in patients presenting with PTB, particularly for those who are older.

Giant ureteral fibroepithelial polyp presenting as a bladder mass resected ureteroscopically: a case report.

Primary ureteral neoplasms are very rare and its prevalence is less than 1% of all genitourinary neoplasms. We report a symptomatic giant ureteral fibro epithelial polyp in adult women presenting as a bladder mass which was resected ureteroscopically and reported at the first time from Iran. Cystoscopy is growing use in the treatment of urinary tract lesions Cystoscopy can be used in large lesions in centers with experience rather than open surgery.