Interpretable generalized neural additive models for mortality prediction of COVID-19 hospitalized patients in Hamadan, Iran.

BACKGROUND: The high number of COVID-19 deaths is a serious threat to the world. Demographic and clinical biomarkers are significantly associated with the mortality risk of this disease. This study aimed to implement Generalized Neural Additive Model (GNAM) as an interpretable machine learning method to predict the COVID-19 mortality of patients. METHODS: This cohort study included 2181 COVID-19 patients admitted from February 2020 to July 2021 in Sina and Besat hospitals in Hamadan, west of Iran. A total of 22 baseline features including patients' demographic information and clinical biomarkers were collected. Four strategies including removing missing values, mean, K-Nearest Neighbor (KNN), and Multivariate Imputation by Chained Equations (MICE) imputation methods were used to deal with missing data. Firstly, the important features for predicting binary outcome (1: death, 0: recovery) were selected using the Random Forest (RF) method. Also, synthetic minority over-sampling technique (SMOTE) method was used for handling imbalanced data. Next, considering the selected features, the predictive performance of GNAM for predicting mortality outcome was compared with logistic regression, RF, generalized additive model (GAMs), gradient boosting decision tree (GBDT), and deep neural networks (DNNs) classification models. Each model trained on fifty different subsets of a train-test dataset to ensure a model performance. The average accuracy, F1-score and area under the curve (AUC) evaluation indices were used for comparison of the predictive performance of the models. RESULTS: Out of the 2181 COVID-19 patients, 624 died during hospitalization and 1557 recovered. The missing rate was 3 percent for each patient. The mean age of dead patients (71.17 ± 14.44 years) was statistically significant higher than recovered patients (58.25 ± 16.52 years). Based on RF, 10 features with the highest relative importance were selected as the best influential features; including blood urea nitrogen (BUN), lymphocytes (Lym), age, blood sugar (BS), serum glutamic-oxaloacetic transaminase (SGOT), monocytes (Mono), blood creatinine (CR), neutrophils (NUT), alkaline phosphatase (ALP) and hematocrit (HCT). The results of predictive performance comparisons showed GNAM with the mean accuracy, F1-score, and mean AUC in the test dataset of 0.847, 0.691, and 0.774, respectively, had the best performance. The smooth function graphs learned from the GNAM were descending for the Lym and ascending for the other important features. CONCLUSIONS: Interpretable GNAM can perform well in predicting the mortality of COVID-19 patients. Therefore, the use of such a reliable model can help physicians to prioritize some important demographic and clinical biomarkers by identifying the effective features and the type of predictive trend in disease progression.

Application of machine learning models based on decision trees in classifying the factors affecting mortality of COVID-19 patients in Hamadan, Iran.

BACKGROUND: Due to the high mortality of COVID-19 patients, the use of a high-precision classification model of patient's mortality that is also interpretable, could help reduce mortality and take appropriate action urgently. In this study, the random forest method was used to select the effective features in COVID-19 mortality and the classification was performed using logistic model tree (LMT), classification and regression tree (CART), C4.5, and C5.0 tree based on important features. METHODS: In this retrospective study, the data of 2470 COVID-19 patients admitted to hospitals in Hamadan, west Iran, were used, of which 75.02% recovered and 24.98% died. To classify, at first among the 25 demographic, clinical, and laboratory findings, features with a relative importance more than 6% were selected by random forest. Then LMT, C4.5, C5.0, and CART trees were developed and the accuracy of classification performance was evaluated with recall, accuracy, and F1-score criteria for training, test, and total datasets. At last, the best tree was developed and the receiver operating characteristic curve and area under the curve (AUC) value were reported. RESULTS: The results of this study showed that among demographic and clinical features gender and age, and among laboratory findings blood urea nitrogen, partial thromboplastin time, serum glutamic-oxaloacetic transaminase, and erythrocyte sedimentation rate had more than 6% relative importance. Developing the trees using the above features revealed that the CART with the values of F1-score, Accuracy, and Recall, 0.8681, 0.7824, and 0.955, respectively, for the test dataset and 0.8667, 0.7834, and 0.9385, respectively, for the total dataset had the best performance. The AUC value obtained for the CART was 79.5%. CONCLUSIONS: Finding a highly accurate and qualified model for interpreting the classification of a response that is considered clinically consequential is critical at all stages, including treatment and immediate decision making. In this study, the CART with its high accuracy for diagnosing and classifying mortality of COVID-19 patients as well as prioritizing important demographic, clinical, and laboratory findings in an interpretable format, risk factors for prognosis of COVID-19 patients mortality identify and enable immediate and appropriate decisions for health professionals and physicians.

Association of interleukin-17 gene polymorphisms and susceptibility to brucellosis in Hamadan, western Iran.

IL-17is one of the most important inflammatory cytokines that stimulate immunity responses in humans infected with Brucella species, acting as a regulator that reduces release of γ-IFN, thus increasing resistance to brucellosis. Gene polymorphisms in the regulatory regions of cytokine-encoding genes affect the amountsof cytokines produced and play a fundamental role in infectious diseases. The aim of this study was to determine the association between IL-17 gene polymorphisms and susceptibility to brucellosis. In this case-control study, 86 patients with brucellosis and 86 healthy persons in Hamadan, western Iran, from September 2014 to September 2016, were included. IL-17 genetic variants at positions rs4711998 A/G, rs8193036 C/T, rs3819024 A/G, rs2275913 A/G, rs3819025 A/G, rs8193038 A/G, rs3804513 A/T, rs1974226 A/G and rs3748067 A/G were analyzed by restriction fragment length polymorphism-PCR. Serum IL-17 titers were measured by sandwich ELISA. GG genotypes at positions rs4711998 and rs3748067 were present significantly more frequently in patients with brucellosis than in controls (P < 0.05). The AA genotype at positions rs4711998, rs2275913 and rs3748067 and GG genotype at position rs19744226 were present significantly more frequently in controls than in the patient group. These results suggest that the AA genotype at positions rs3748067, rs3819025 and rs4711998 and GG genotype at position rs3819024 are likely protective factors against brucellosis, whereas the GG genotype at positions rs3748067, rs3819025 and rs4711998 and AA genotype at position rs3819024 may be risk factors against the disease. No significant relationships were found between serum IL-17 titers and genotypes of the single-nucleotide polymorphisms.

NBS superfood: a promising adjunctive therapy in critically ill ICU patients with omicron variant of COVID-19.

This clinical trial aimed to assess the impact of Nutrition Bio-shield superfood (NBS) on clinical status among critically ill ICU patients suffering from acute respiratory distress syndrome (ARDS) due to the Omicron variant of COVID-19. A total of 400 patients with confirmed Omicron-related ARDS were randomly assigned to either the intervention group (n = 200) or the control group (n = 200). Patients in the intervention group received 1.5 g of NBS powder daily for 2 weeks in addition to standard antiviral treatment, while the control group received a placebo alongside standard antiviral therapy. Serum samples were collected from all patients in both groups, and various clinical and laboratory parameters, including ESR, CRP, D-Dimer, CPK, WBC count, lymphocyte count, and lymphocyte percentage, were measured using established methodologies. Following a 14-day intervention period, the intervention group exhibited a significant reduction in mean serum levels of CRP (15.39 vs. 48.49; P < 0.001), ESR (14.28 vs. 34.03; P < 0.001), D-Dimer (485.18 vs. 1009.13; P = 0.001), and CPK (68.93 vs. 131.48; P < 0.001) compared to the control group. Conversely, a significant increase was observed in the mean serum levels of lymphocytes (1537.06 vs. 1152.60; P < 0.001) in the intervention group after 14 days of treatment compared to the control group. The remarkable reduction in inflammatory markers and mortality rates observed with NBS supplementation alongside standard antiviral treatment underscores its crucial role in mitigating inflammation and achieving an important milestone in the fight against COVID-19.

Susceptibility and Severity of COVID-19 Are Both Associated With Lower Overall Viral-Peptide Binding Repertoire of HLA Class I Molecules, Especially in Younger People.

An important number of studies have been conducted on the potential association between human leukocyte antigen (HLA) genes and COVID-19 susceptibility and severity since the beginning of the pandemic. However, case-control and peptide-binding prediction methods tended to provide inconsistent conclusions on risk and protective HLA alleles, whereas some researchers suggested the importance of considering the overall capacity of an individual's HLA Class I molecules to present SARS-CoV-2-derived peptides. To close the gap between these approaches, we explored the distributions of HLA-A, -B, -C, and -DRB1 1st-field alleles in 142 Iranian patients with COVID-19 and 143 ethnically matched healthy controls, and applied in silico predictions of bound viral peptides for each individual's HLA molecules. Frequency comparison revealed the possible predisposing roles of HLA-A*03, B*35, and DRB1*16 alleles and the protective effect of HLA-A*32, B*58, B*55, and DRB1*14 alleles in the viral infection. None of these results remained significant after multiple testing corrections, except HLA-A*03, and no allele was associated with severity, either. Compared to peptide repertoires of individual HLA molecules that are more likely population-specific, the overall coverage of virus-derived peptides by one's HLA Class I molecules seemed to be a more prominent factor associated with both COVID-19 susceptibility and severity, which was independent of affinity index and threshold chosen, especially for people under 60 years old. Our results highlight the effect of the binding capacity of different HLA Class I molecules as a whole, and the more essential role of HLA-A compared to HLA-B and -C genes in immune responses against SARS-CoV-2 infection.

The effects of nutrition bio-shield superfood powder on immune system function: A clinical trial study among patients with COVID-19.

The present study aimed to evaluate the effects of Nutrition Bio-shield Superfood (NBS) powder on the immune system function and clinical manifestations in patients with COVID-19. We compare the effects of NBS powder on the immune system function and clinical manifestations among two different groups: 1) intervention group receiving standard treatment scheduled according to treatment guidelines plus NBS powder, and 2) control group receiving only the same standard treatment. The serum levels of IL-2, IL-6, IL-17, IFNγ, and TNFα were determined after four weeks of treatment by specific ELISA kits according to the manufacturer's instructions. Finally, the level of immune system stimulation and inflammatory markers were compared at baseline and after intervention in both groups. Data were analyzed using SPSS (version 22). A p-value of ≤ 0.05 was set as significant. A total of 47 patients with COVID-19 (24 patients in the intervention group and 23 patients in the control group) were included in this study. Results showed that the differences in the mean decrease of IL-2, IL-6, and TNF-α in the intervention group in comparison to the control group were 0.93, 10.28, and 8.11 pg/ml, respectively (P<0.001). On the other hand, there was no difference in IL-17, IFNγ, monocytes, eosinophil, and other inflammatory indices between the intervention and control groups. Although NBS powder was able to significantly decrease the levels of some proinflammatory cytokines in patients with COVID-19, however, it is noteworthy that the course of the disease was to large part unaffected by NBS power and there was a reduction independent of treatment. The present study indicates that NBS powder could provide a beneficial anti-inflammatory effect in patients with COVID-19. Hence, NBS in treating patients with COVID-19 shows promise as an adjuvant to the current standard antiviral treatment of such patients. Clinical Trial Registration: https://www.irct.ir, identifier IRCT20200426047206N1.

Establishment of brucellosis relapse and complications registry: a study protocol.

Brucellosis is an endemic bacterial zoonotic disease in developing countries; that is a serious public health problem in Iran. Brucellosis is a life-threatening multi-system disease in human with different clinical manifestations, complications and relapse. The incidence of brucellosis in Hamadan province, west of Iran is high. In addition, there is few reliable and population-based studies regarding relapse and complications of brucellosis in developing countries, therefore establishment of the registry system in areas with adequate occurrence of cases is needed to better understand the predictors of brucellosis relapse and complications and management of the disease. Detecting occurrence of relapse and complications over time and by geographical area provide information for further investigations and identification of health system deficiencies in the management of patients.

Seroprevalence of Brucellosis among General Population in Famenin City, Western Iran in 2016: The Famenin Brucellosis Cohort Study.

BACKGROUND: Brucellosis is endemic in Iran with a higher level of endemicity in western areas, including the Hamadan province. This study aims to define the seroprevalence of brucellosis and it,s risk factors in general the population of Famenin, Hamadan province, in western Iran. METHODS: This survey was conducted on 2367 participants in Famenin and its villages from September to November 2016. After receiving written consent from subjects, demographic information was obtained through questionnaires and 10cc blood samples were taken from the participants. Blood samples were sent to the Core facility of Hamadan University of Medical Sciences and were tested using Wright and 2ME kits (Pasteur Institute, Iran) for serological detection of brucellosis. The seroprevalence of brucellosis was reported as percentage with 95% confidence interval (CI). RESULTS: Totally, 2367 individuals with the mean age (SD) of 34.6 (20.9) (range: 2 to 95) years were enrolled. Of these, 1060 (44.8%) were men and 1610 (68.0%) lived in rural areas. The seroprevalence of brucellosis according to the Wright titer (equal to or greater than 1:80) was 6.6% (95% CI: 5.62%, 7.66%). The corresponding prevalence based on 2ME titers (equal to or greater than 1:40) in subjects with positive Wright test was 37.2% (95% CI: 29.5%, 44.84%). We saw a significant association between the incidence of brucellosis and occupation (P < 0.001) and type of contact with livestock (P = 0.009) as two important risk factors. CONCLUSION: The seroprevalence of brucellosis in Famenin population was considerable. Contact with livestock, animal husbandry, farming and history of brucellosis were risk factors for brucellosis infection.

A comparative trial of three therapeutic regimens: ciprofloxacin-rifampin, ciprofloxacin-doxycycline and doxycycline-rifampin in the treatment of brucellosis.

This study was designed to compare the efficacy of ciprofloxacin plus rifampin (CR) and ciprofloxacin plus doxycycline (CD) versus doxycycline plus rifampin (DR) in the treatment of brucellosis. A total of 178 patients with brucellosis who were referred to the Sina Hospital, Hamedan, Iran, were included. The responses to therapy were observed in 166 cases (93.7%) - 59 were in the DR group, 59 in the CR group and 48 in the CD group. No significant differences in the therapeutic responses were observed (P = 0.09). Relapse was observed in 11.7% (DR 7.7%, CR 8.3% and CD 17.5%) after a six-month follow-up. No significant differences were also observed in relapse rates among the three groups (P = 0.35). We concluded that DR is still the first choice regimen and CR or CD may be used as alternatives for treatment of brucellosis in adults.

Study on the frequency of hepatitis B and C infection in chronic psychiatric patients in Hamedan in 2006-2007.

OBJECTIVE: To study on the frequency of hepatitis B and C infections in chronic psychiatric patients in Day Night Patient Care Centres in Hamedan in 2006-2007. METHODS: This is a cross sectional study done on 170 patients with chronic mental disorders admitted in patient care institutions of Hamedan in 2006-2007. Positive tests for HCV-Ab were confirmed by RIBBA test. RESULTS: Of 170 patients, 56% were males and 44% were females, (age range 15-71 years). Hepatitis B and C infection was found only in males, with Hepatitis B in 1.8% patients. All of Hepatitis B cases two thirds of Hepatitis C cases were institutionalized in one of the centers. CONCLUSIONS: Overall frequency of Hepatitis B and C infections in chronic psychiatric patients in care centers is more than the general population and centralization of these cases in one center causes transmission of infection if the standard precautions are not observed.

Increased serum levels of hepcidin and C-reactive protein in patients with brucellosis.

Background: Increased serum level of C-reactive protein (CRP) as a classic acute phase protein has commonly been reported in acute brucellosis. Hepcidin is also an acute phase protein and has a critical role in host defense. The aim of this study was to compare the level of hepcidin and CRP in patients with brucellosis. Methods: All patients with brucellosis referred to Sina Hospital during a 10-month period were included. Serum samples were checked for hepcidin levels in patients and also in the control group. Information on demographic and clinical characteristics was determined through completion of a questionnaire. Results: A total of 42 patients with brucellosis and 42 healthy controls were enrolled. The most common symptoms of brucellosis were fever (76%) and arthralgia (69%). The mean serum level of hepcidin in patients (42.6±11.7 pg/mL) was significantly higher than in the controls (17.3±4.2 pg/mL) (p<0.001). The mean serum levels of CRP in patients and controls were 12.6±12.2 and 3.1±2.4 mg/L, respectively (p=0.001). Conclusions: Increased serum levels of hepcidin in brucellosis can be considered a diagnostic biomarker of inflammation and active disease. Further studies are needed to identify the role of hepcidin as a host defense mechanism in brucellosis.

Seroprevalence of Brucellosis in Butchers, Veterinarians and Slaughterhouse Workers in Hamadan, Western Iran.

BACKGROUND: Brucellosis is a zoonotic disease caused by Brucella species via infected domestic animals. In endemic areas, certain occupations such as veterinarians, butchers, and slaughterhouse workers are considered high risk regarding brucellosis. We evaluated the seroprevalence of brucellosis in high-risk occupations in Hamadan, West of Iran. STUDY DESIGN: a cross-sectional study. METHODS: Overall, 218 participants from 2014 to 2015 were enrolled. A questionnaire including demographic data, length of employment, and using personal protective equipment was completed for each of them. Then, blood samples were taken and sent to Hamadan Health Center to be tested by Wright or standard tube agglutination (STA). In addition, samples with positive Wright test were examined by 2-mercaptoethanol (2ME) test. Then, seropositive participants were evaluated for clinical manifestations of brucellosis. All collected data were analyzed by SPSS ver. 16. RESULTS: The mean age of the participants was 42.79±11.16 yr and all seropositive cases were male. Based on Wright ≥1/80 and 2ME ≥1/40, seroprevalence of brucellosis was 13.3% and 12.3%, respectively. The use of personal protective equipment was low among individuals with or without brucellosis. Myalgia, fatigue, back pain, joint pain, night sweats, fever, malaise, and headache were common symptoms in seropositive cases. Moreover, 20.6% of the seropositive participants were asymptomatic. CONCLUSIONS: High prevalence of brucellosis in these occupational groups and symptomatic disease in significant numbers of them, so periodic clinical examinations in these groups seems to be essential for brucellosis surveillance system.

Effect of hydroxychloroquine on treatment and recurrence of acute brucellosis: a single-blind, randomized clinical trial.

Brucellosis is associated with a high recurrence rate and requires more than one course of standard treatment; therefore, more research is required to find more effective treatments that lead to prompt recovery, and reduce the relapse of disease. This single-blind, randomized study was designed to evaluate the effect of the standard treatment for brucellosis in combination with hydroxychloroquine. A total of 177 patients with acute brucellosis were randomly assigned to one of two treatment groups: doxycycline-streptomycin (DS) and doxycycline-streptomycin-hydroxychloroquine (DSH). Clinical symptoms and signs, serological tests, and side effects of therapy were compared between the two groups during the treatment course and at three and six months after the end of drug therapy. Of the 177 patients, with a mean age of 40.5 ± 16.9 years, 66.1% were males. The mean duration of clinical signs prior to admission was 43.4 ± 41.1 days. Appropriate clinical responses, relapse, treatment failure, and adverse drug reactions were seen in 98.9%, 1.2%, 0.0%, and 12.6% of patients, respectively, in the DSH group vs. 86.7%, 11.6%, 2.3%, and 19.8% of patients, respectively, in the DS group. There were significant differences in clinical response and relapse rates between the two groups. The addition of hydroxychloroquine to a doxycycline-streptomycin regimen appears to increase the efficacy of treatment, accelerate improvement of clinical symptoms, and significantly reduce the rate of relapse of brucellosis.

Isolated hepatitis B core antibody in HIV infected patients--can response to hepatitis B vaccine help to elucidate the cause?

BACKGROUND: Concomitant hepatitis B and HIV infections are common. In some of these patients, HBcAb is the only serologic marker of hepatitis B. This study was conducted to elucidate the cause of isolated HBcAb in HIV-infected patients via hepatitis B vaccination. METHODS: In this interventional study during 2014-15 in the HIV Clinic in Hamadan, thirty four patients with HIV infection and isolated HBcAb positive isolate, received hepatitis B vaccine and their responses to vaccination were investigated. Demographic data, stage of disease, and status of CD4 and HCV Ab were extracted from the patients' medical records and were entered in a checklist. RESULTS: Of the 103 HIV positive patients, the prevalence of HBs Ag, and HBc Ab isolates were 6.79% (n=7) and 46.6% (n=48), respectively. All of the patients with isolated HBcAb were positive for HCV Ab. Among the 48 patients with isolated HBc Ab, 34 (70.8%) were available and examined for HBV DNA in serum samples. The result of PCR was negative in all. After the first round of hepatitis B vaccination, HBs Ab titer exceeded 10 International Units Per Liter (IU/L) in 58.8% of patients with isolated HBc Ab. With the completion of the three-dose of vaccine, this titer was observed in 97% of patients. Significant correlation was observed between titer of antibodies and values of CD4 cells. CONCLUSIONS: Due to favorable response to hepatitis B vaccination in HIV positive patients with isolated HBc Ab, false positive HBc Ab and recovery from previous infection were more probable than hidden hepatitis B.

Comparison between doxycycline-rifampin-amikacin and doxycycline-rifampin regimens in the treatment of brucellosis.

BACKGROUND: Combination drug therapy of brucellosis leads to recovery of symptoms, shortening of symptomatic interval, and decrease in morbidity rate, but single drug therapy is associated with more relapse episodes and a higher rate of drug resistance. Different drug combinations have been evaluated in the treatment of brucellosis. Considering the failure of treatment and relatively high rate of relapse of the disease with the World Health Organization's (WHO) recommended therapeutic regimen, we evaluated a new regimen that we assumed would increase the success of treatment and decrease the rate of relapse. In this study we compare the standard regimen of the WHO, doxycycline-rifampin (DR), to triple therapy with doxycycline-rifampin-amikacin (ADR). METHODS: Two hundred and twenty-eight consecutive patients with brucellosis, who attended Hamedan Sina Hospital between 1999 and 2001, whether seen as outpatients or as inpatients, were enrolled in the study. The participants were randomly allocated to the DR group (receiving doxycycline 100 mg twice a day and rifampin 10 mg/kg body weight/day every morning, both taken orally for eight weeks) or the ADR group (receiving doxycycline 100 mg twice a day and rifampin 10 mg/kg body weight/day every morning, both taken orally for eight weeks, plus 7.5 mg/kg amikacin intramuscularly twice a day for seven days). The patients were checked for the relief of symptoms, drug side-effects, and relapse of disease during the treatment and follow-up. RESULTS: Of the 228 patients enrolled, eight were withdrawn - four patients from the DR group and four from the ADR group. Of the remaining 220 participants (110 in the ADR group and 110 in the DR group), 107 were male (48.6%) and 113 were female (51.4%). Mean age was 35.7+/-17 years in the ADR group and 37+/-18.4 years in the DR group (p=0.5). In the DR group, 97 (88.2%) and in the ADR group, 106 (96.4%) of the patients had relief of symptoms (a significant difference by Chi-square test (p=0.04)). After completion of treatment, and at the sixth month follow-up, nine (9.3%) patients in the DR group and six (5.7%) in the ADR group experienced a relapse of the disease, with no significant difference (p=0.4). Mild side-effects were found in only 10 patients, and none required discontinuation of the therapeutic regimen. Of these patients, four were from DR group and six from ADR group; no significant difference was observed (p=0.7). CONCLUSIONS: Given the fact that the ADR regimen had a higher efficacy and more rapid action in terms of relief of symptoms compared to the DR regimen, and that no significant difference in drug side-effects and disease relapse existed in the patients of either group, adding amikacin to the DR standard treatment regimen seems beneficial.

Osteoarticular complications of brucellosis in Hamedan, an endemic area in the west of Iran.

OBJECTIVE: To determine the frequency and clinical characteristics of osteoarticular complications of brucellosis in an endemic region in Iran. METHODS: In a prospective study we evaluated 245 patients with brucellosis diagnosed between January 2004 and December 2005. Patients included were those older than 8 years of age and who had clinical features suggestive of brucellosis and specific antibodies at significant titers, and/or positive blood or body fluid culture for Brucella species. A bone scan was performed in those with a clinical suspicion of osteoarticular involvement. RESULTS: Seventy patients (28.6%) had osteoarticular complications. Sacroiliitis was the most common complication (75.7%), followed by spondylitis (21.4%) and peripheral arthritis (8.6%). Spondylitis was the most common osteoarticular complication in the elderly. Relapses occurred in five (2%) patients, three of them with spondylitis. CONCLUSIONS: Osteoarticular disease is the most common complication of brucellosis in Western Iran. Sacroiliitis is the most common form of osteoarticular complication. With the use of a proper treatment regimen, the prospect for recovery is good.

Association between serum concentration of 25-hydroxyvitamin D and community-acquired pneumonia: a case-control study.

BACKGROUND: Community-acquired pneumonia (CAP) is a common disease with significant morbidity and mortality. There is evidence that vitamin D deficiency can be associated with infectious diseases. The aim of this study was to compare the levels of vitamin D between patients with CAP and healthy controls. METHODS: In a case-control study on 73 patients with CAP and 76 healthy controls, the serum concentration of 25-hydroxyvitamin D (25[OH]D) was measured. Severity and outcomes of disease and also duration of hospital stay were compared in patients with different levels of 25(OH)D. The severity of CAP was assessed using the CURB-65 score (confusion, uremia, respiratory rate, low blood pressure, age ≥65 years) and was also reflected by the length of hospital stay, admission to intensive care unit (ICU), and 30-day mortality. RESULTS: In total, 81.2% of the study population had vitamin D levels <30 ng/dL. The risk of pneumonia among subjects with deficient vitamin D levels was 3.69 (95% CI: 1.46, 9.31) times of those with sufficient vitamin D level (P=0.006). Prevalence of severe deficiency of vitamin D in scores three and four of CURB-65 (59.38%), was far more than scores one and two (31.71%). Also, results indicated patients with severe deficiency had a higher risk for ICU admission, 30-day mortality, and longer hospitalization stay, but these were not statistically significant. CONCLUSION: According to findings, a low level of 25(OH)D is associated with a higher incidence of CAP and more severe disease. It is recommended to pay more attention to vitamin D deficiency in infectious diseases, particularly in CAP patients.

Seroprevalence of hepatitis e among hemodialysis patients: a report from hamadan, iran.

BACKGROUND: Previous studies have documented a high prevalence of hepatitis E among patients undergoing maintenance hemodialysis. Available studies reporting on the seroprevalence of hepatitis E in hemodialysis patients in Iran, an endemic region for the disease, are sparse. OBJECTIVES: The present study aimed to determine the prevalence rate of anti-hepatitis E antibody in hemodialysis patients in Hamadan, Iran. PATIENTS AND METHODS: In this cross-sectional study, all 153 consecutive patients undergoing hemodialysis in two centers were enrolled. Patients' demographic and clinical data were collected, using a standard questionnaire and from medical records. Serum immunoglobulin G concentrations against hepatitis E were determined using the enzyme linked immunosorbent assay method. RESULTS: Thirty patients (19.2%), were seropositive. Seropositive patients were not significantly different from seronegative patients, with regard to age, sex, level of education, access to filtered water, and duration and frequency of hemodialysis. The proportions of patients with hepatitis B, C, and HIV infection were comparable between the two groups. CONCLUSIONS: One in five patients undergoing maintenance dialysis in Hamadan is seropositive for hepatitis E immunoglobulin G antibody. Future studies are needed to investigate the factors contributing to the observed high prevalence rate and the possibility of parenteral transmission of hepatitis E.

Antibacterial susceptibility of Escherichia coli among outpatients with community-acquired urinary tract infection in Hamadan, Iran.

Escherichia coli is the main cause of community-acquired urinary tract infections (UTIs). The aims of the present study were to examine the susceptibility profile of E. coli causing UTIs and to identify factors associated with antimicrobial resistance. A cross-sectional study was conducted in Hamadan City, Iran, between 2012 and 2013. Patients referred to Farshchian or Shahid Beheshti Hospitals and diagnosed with UTI caused by E. coli were enrolled in the study. Susceptibility testing to commonly used antimicrobial agents was performed by the disk diffusion method. Relevant data were abstracted, and analysis was performed to identify factors associated with antimicrobial resistance. A total of 154 patients were enrolled in the study. Among the respective number of E. coli isolates, the highest susceptibility was observed to nitrofurantoin (94.1%) and gentamicin (86.4%) and the lowest to amoxicillin/clavulanic acid (35.1%), trimethoprim/sulfamethoxazole (38.3%) and ciprofloxacin (51.9%). Twenty-four isolates (15.6%) were susceptible to all antimicrobial tested, 31 (20.1%) were resistant to one agent and 99 (64.3%) exhibited resistance to at least two different classes of antibiotics [multidrug-resistant (MDR) phenotype]. Patients with prior use of antibiotics during the past 3 months and those who had an episode of UTI in the past 2 years were at higher risk of being infected with MDR E. coli (P=0.034 and P=0.001, respectively). In conclusion, a substantial proportion of E. coli causing UTI exhibited a MDR phenotype. History of UTI and prior use of antibiotics were associated with increased risk of infection caused by MDR E. coli.

Effectiveness of hepatitis B vaccination in children of chronic hepatitis B mothers.

OBJECTIVE: Although all newborns in Iran have been vaccinated against hepatitis B since March 1993, routine screening of pregnant women has not been conducted in prenatal care programs, yet transmission of hepatitis B via the maternal-fetal route is still a viable likelihood, which must be entertained. METHODS: The subjects were divided into 2 groups. The exposed group comprised 97 vaccinated children whose mothers were seropositive for hepatitis B surface antigen (HBsAg) and had not received hepatitis immunoglobulin at birth. The unexposed group consisted of 87 vaccinated children whose mothers were seronegative for hepatitis B surface antigen. We compared these 2 groups to determine the efficacy of vaccine alone in high-risk children. This study was conducted in Tehran, Iran, from June 2002 to December 2002. All children were born after 1993. RESULTS: Chronic infection (HBsAg positivity) was detected in 14.3% of children in the exposed group. There were no instances of chronic infection in the unexposed group (relative risk [RR]=13.48, 95% confidence intervals [CI] 1.8-100.02). Previous infection of hepatitis B (HBcAb positivity) was found in 29 (29.9%) children in the exposed group, but only one (1.2%) in the unexposed group (RR=26.01, 95% CI: 3.61-186.95). Immunity (HBsAb positivity) in the exposed group measured 48 (49.5%) and unexposed group measured 56 (64.4%) (R.R=0.76, 95% CI: 0.59-0.99). CONCLUSION: Vaccination alone did not induce immunity against hepatitis B in high-risk children; it seems that routine screening of pregnant women is necessary for determining whether neonates need hepatitis B immunoglobulin after birth.