Comparative analysis of infective endocarditis in hemodialysis versus non-hemodialysis patients in Iran: implications for clinical practice and future research.

BACKGROUND: In hemodialysis (HD) patients, there is a larger frequency of mortality and morbidity associated with infective endocarditis (IE) as opposed to the general population. Despite the increased burden of IE in the HD population, optimal strategies for prevention and management still need to be clarified. Elucidating the distinguishing features and outcomes of IE in HD patients is crucial to guide clinical decision-making and improve prognosis in this high-risk group. However, the details of IE characteristics, specifically in HD patients in the Middle East, are limited. OBJECTIVE: To compare the clinical characteristics and short-term outcomes of IE between HD and non-HD patients. METHODS: A retrospective analysis was carried out on 139 patients with infective endocarditis who were referred to a tertiary cardiovascular center in Iran from 2006 to 2018. The participants were split into HD (n = 34) and non-HD (n = 105) groups. Data pertaining to demographic characteristics, comorbidities, microbiological findings, occurrence of complications, therapeutic interventions, and mortality rates during hospital stay were gathered. RESULTS: Diabetes, hypertension, and congestive heart failure were observed more frequently in HD patients. HD patients were more likely than non-HD patients to have involvement of the right valve (41.2% vs. 20.9%), larger vegetation, and extracardiac emboli. In-hospital mortality was 41.2% for HD patients versus 14.3% for non-HD patients. Mortality remained high after valve surgery in HD patients (38.2% vs. 10.5% in non-HD). CONCLUSION: HD patients exhibited a distinct clinical profile of IE with worse short-term outcomes, including higher mortality.

Risk factors prediction, clinical outcomes, and mortality in COVID-19 patients.

Preventing communicable diseases requires understanding the spread, epidemiology, clinical features, progression, and prognosis of the disease. Early identification of risk factors and clinical outcomes might help in identifying critically ill patients, providing appropriate treatment, and preventing mortality. We conducted a prospective study in patients with flu-like symptoms referred to the imaging department of a tertiary hospital in Iran between March 3, 2020, and April 8, 2020. Patients with COVID-19 were followed up after two months to check their health condition. The categorical data between groups were analyzed by Fisher's exact test and continuous data by Wilcoxon rank-sum test. Three hundred and nineteen patients (mean age 45.48 ± 18.50 years, 177 women) were enrolled. Fever, dyspnea, weakness, shivering, C-reactive protein, fatigue, dry cough, anorexia, anosmia, ageusia, dizziness, sweating, and age were the most important symptoms of COVID-19 infection. Traveling in the past 3 months, asthma, taking corticosteroids, liver disease, rheumatological disease, cough with sputum, eczema, conjunctivitis, tobacco use, and chest pain did not show any relationship with COVID-19. To the best of our knowledge, a number of factors associated with mortality due to COVID-19 have been investigated for the first time in this study. Our results might be helpful in early prediction and risk reduction of mortality in patients infected with COVID-19.

Cardiovascular patients in COVID-19 era, a case series, an experience from a tertiary cardiovascular center in Tehran, Iran.

Different cardiovascular presentations of coronavirus disease 2019 can be seen because of the systemic involvement. Considering its new presentations, there is need for further studies regarding the mechanistic pathways involved.

Prevalence and antibiotic resistance of Acinetobacter baumannii among patients in postcardiac surgery intensive care units of Rajaei Hospital, Tehran.

Background: Acinetobacter baumannii is an opportunistic, aerobic, nonfermentative, Gram-negative bacterium that can cause major nosocomial infections, especially in patients hospitalized in intensive care units (ICU). Recently, A. baumannii strains have been resistant to a variety of antibiotics. Thus, it was aimed to evaluate the prevalence of A. baumannii and their resistance to the antibiotics in the patients hospitalized in postcardiac surgery ICU. Methods: This retrospective cross sectional study was performed in Rajaei hospital between March 2014 and February 2016. A. baumannii strains were isolated from blood cultures, catheter cultures, sputum cultures, and wound smear cultures. Then, isolates were characterized using standard morphological, cultural, and biochemical properties according to CLSI 2016. The frequency of A. baumannii species were reported as percent. Results: Among 27 167 patients were admitted to the ICU, 113 individuals, including 55 males and 58 females, were identified as A. baumannii-infected and the prevalence rate was 0.42%. The highest rates of antibiotic sensitivity were related to Meropenem 20 (17.7%) and Colistin 16 (14.1%). The shortest length of stay (LOS) for patients with A. baumanniiin the ICU was 3 days, while the longest LOS was 98 days. Conclusion: The findings indicated that A. baumannii strains isolated from postcardiac surgery ICUs had a high prevalence and were sensitive to Meropenem and Colistin. However, new molecular-based techniques are needed to monitor nosocomial infections. Therefore, the treatment of the patients may be feasible by appropriate antibiotic therapy, and infection control policies will be improved by adopting precise disinfection strategies.

Q Fever Endocarditis in Iran.

Patients with the underlying valvular heart disease are at the high risk of developing sub-acute or chronic endocarditis secondary to Coxiella burnetii. Q fever endocarditis is the most common manifestation along with persistent the infection. There is some serologic and molecular evidence of C. burnetii infection in humans and livestock in Iran. As it is possible to observe chronic Q fever in Iran, it seems necessary to study the prevalence of Q fever endocarditis in this country. In the present study, Infective Endocarditis (IE) patients (possible or definite based on Duke Criteria) hospitalized in Rajaie Cardiovascular Medical and Research Center were enrolled from August 2016 to September 2018. Culture-negative endocarditis patients were evaluated by Raoult criteria for diagnosis Q fever endocarditis. The serological results for brucellosis were negative for all subjects. All blood and tissue samples including valve samples were tested for C. burnetii infection using serology and Polymerase Chain Reaction (PCR). In this study, 126 patients who were admitted to the hospital were enrolled; of which 52 subjects were culture-negative IE. Among the participants, 16 patients (30.77%) were diagnosed with Q fever IE and underwent medical treatment. The mean age of patients was 46.6 years ranging from 23 to 69 years and 75% of them were male. Considering the high prevalence of Q fever IE, evaluation of the patients with culture-negative IE for C. burnetii infections was highly recommended.

Molecular prevalence of Coxiella burnetii in milk in Iran: a systematic review and meta-analysis.

Q fever is a major zoonotic disease in the world. The aim of this meta-analysis was to estimate the prevalence of Coxiella burnetii in animal milk in Iran. We systematically reviewed the literature to identify eligible studies from January 2008 to June 2016 in English or Farsi (Persian) databases. We extracted the molecular prevalence of C. burnetii in milk from cows, goats, sheep, and camels in Iran. The total prevalence of C. burnetii in cow milk was 15.09% (95% CI 11.08-19.10) by PCR methods. The highest and lowest prevalence of Q fever agent were seen in the East Azerbaijan (25.55%) and Khorasan-Razavi (4.22%) provinces, respectively. The molecular prevalence of C. burnetii in goat milk was 7.80% (95% CI 3.54-12.07%). The provinces of Qom (0%) and Lorestan (44.71%) had the lowest and the highest frequency of C. burnetii infection in goat's milk, respectively. Total prevalence of C. burnetii in sheep milk was 3.79% (95% CI 0.72-6.87%). The highest frequency of C. burnetii in sheep milk was detected in the Khorasan-Razavi province (34.78%). The frequency of C. burnetii in camel milk was 1.43%. High infection of C. burnetii in milk is an important health problem in Iran, amplified by the traditional preparations of dairy products.

Genetic evidence of Coxiella burnetii infection in acute febrile illnesses in Iran.

Mounting evidence suggests that Q-fever is more prevalent in Iran than originally believed. However, in most parts of the country, clinicians do not pay enough attention to Q fever in their differential diagnosis. The aim of this study was to investigate the prevalence of Coxiella burnetii in suspected cases of acute Q fever in north-western Iran using molecular techniques. Febrile patients were enrolled in the study and investigated for C. burnetii infection. Sera samples were tested using real-time PCR for detection of IS1111 gene, and positive samples were confirmed with nested PCR. Nine patients (4.2%) out of 216 suspected cases were positive for C. burnetii. Weakness and fatigue, headache, and lethargy were the most prevalent clinical symptoms in acute Q fever patients. According to the results of this study and other reports of human cases in Iran, the diagnosis system of Q fever in Iran should be urgently revamped.

Bilateral Presumed Tuberculous Choroiditis.

PURPOSE: To describe a case of bilateral presumed tuberculous choroiditis which resolved promptly with a short course of antituberculous therapy. CASE REPORT: A 44-year-old lady presented with bilateral visual loss of 8 months'duration. Considering the presence of pan-uveitis, severe macular edema, multifocal leakage on fluorescein angiography, positive tuberculin skin test, and after excluding other diseases, she underwent anti-tuberculous therapy (ATT) for disseminated choroiditis due to presumed ocular tuberculosis. She improved promptly and completely. There were no signs of relapse 18 months after completion of the treatment course. In a young patient with disseminated choroiditis and relatively short duration of symptoms, a course of ATT for 6 months may effectively treat the disease preventing relapse for a considerable period of time. CONCLUSION: In Presumed Tuberculous chroiditis early diagnosis is crucial for prompt and complete improvement.

Disseminated tuberculosis in an AIDS/HIV-infected patient.

Disseminated tuberculosis (TB) is commonly seen in HIV-infected patients and is major cause of death in these patients. In HIV-infected patients disseminated tuberculosis is frequently undiagnosed or misdiagnosed. In this article we report a case of disseminated TB in a HIV-infected patient with a relatively long history of fever and other complaints without definite diagnosis. Diagnosis of disseminated TB was confirmed by bone marrow biopsy and polymerase chain reaction analysis (PCR) of the ascitic fluid. With anti-TB treatment signs and symptoms improved.

Intestinal tuberculosis sometimes mimics Crohn's disease.

Intestinal tuberculosis is an uncommon presentation of tuberculosis (TB) and has clinicopathological similarities with Crohn's disease. In regions where TB is endemic clinicians must aware of this condition and fully evaluate their patients when Crohn's disease is diagnosed. We recommend all pathologic specimens be evaluate effectively for TB.Smear,culture and PCR for Mycobacterium.tuberculosis from samples aside the pathological reviews help for better diagnosis. Here we present a case of intestinal tuberculosis which initially diagnosed as Crohn's disease but after starting immunosuppressive agents he presented with disseminated tuberculosis.