Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Laboratory features of patients with Brucellosis and its association with titer of Wright agglutination test

Background: One of the features of Malta fever is diversity of hematologic manifestations. The Aim of This study was to evaluate hematologic findings of brucellosis and its association with titer of wright agglutination test. Materials & Methods: This study was a cross - sectional and analytical study that was conducted on 189 patients with brucellosis in the Arak in 2011. The diagnostic criteria of the disease were the Wright test and 2-Mercaptoethanol (2ME) agglutinin assay with titers greater than 1:160 and 1:80, respectively, and clinical symptoms compatible with brucellosis. Data were obtained from patient records and were analyzed with SPSS version 16. Results: From 189 patients with Brucellosis who were enrolled in study 67.8% was male, Mean age in men was 37.8±23.3 years and in women 36.9±15.3 years. Erythrocyte sedimentation rate in 44.5% was between 21- 40 and in 2.1% was above 60. 45% of patients had qualitative CRP levels higher than +2. Leukopenia in 9%, anemia 19%, thrombocytopenia 7.4% was seen. In 27.8% the lymphocyte cell count was predominant. 7.5% of patients had eosinophilia of more than 5% and 4.8% with bicytopenia and 1.6% had pancytopenia. The association between titer of wright test and sex, ESR, leucopenia, thrombocytopenia and anemia was not observed, (P>0.05) but with CRP>1+ (P=0.0001) and age over 45 years (P= 0.017 association was significant. Conclusion: Brucellosis should be considered as a differential diagnosis among patients whose blood picture reveals anemia, leukopenia, thrombocytopenia or pancytopenia. There is no relation between wright titer and hematologic manifestation. In comparison with similar studies in other countries, hematologic abnormality is lower in our patients

مروري گذرا بر آرا و نظرات ابن سینا، اخوینی و تفلیسی در باب تب و تشخیص بیماری‌ها و مقایسه آن با طب نوین

Background: Since olden times, fever and its diagnostic features have been always paid attention to. The aim of this study was to investigate the views of Iranian Islamic scholars, Avicenna, Tbilisi and Akhaveayne on fever and their compatibility with modern sciences. Methods: The authors tried to refer to authentic and reliable sources for fever in traditional medicine and compare them with modern medicine and arrange their findings into a descriptive article. To collect valid data a comprehensive library search as well as an electronic one, using appropriate keywords, were carried out. Results: Based on the data collected and according to Iranian traditional medicine the root of fever lay in the disorders of other organs which could be helpful in the diagnosis of illnesses. In traditional medicine, fever was divided into different types like sanguine (of blood), melancholic, phlegmatic, daily fever, and so on.In Iranian traditional medicine careful examination of the patient as well as the background leading to fever were of utmost importance and a lot of foods prescribed for the treatment of fever were consistent with the standards of modern medicine. Conclusion: Given that in modern medicine many causes of fever are still unknown, a new approach to the traditional diagnostic and therapeutic views on fever can compensate for the insufficiencies of modern medicine in this regard.سابقه و هدف: توجه به تب و ویژگی‌های آن از گذشته نیز در تشخیص بیماری‌ها مورد توجه بوده است. هدف از مطالعه حاضر بررسی نظرات اندیشمندان ایران اسلامی شامل ابن سینا، اخوینی و تفلیسی در زمینه پدیده تب و تطابق آن با علوم جدید می‌باشد. روش بررسی: در این مقاله سعی شده است از طریق دسترسی به منابع معتبر در قالب یک مقاله توصیفی نظرات اندیشمندان ایران اسلامی در زمینه تب و تشخیص بیماری‌ها مورد بررسی و با علم پزشکی امروز مقایسه گردد. جهت این کار با استفاده از کلید واژه‌های مناسب و جستجوی الکترونیکی و دستی در منابع معتبر اطلاعات گرداوری و به هدف محوری پژوهش پرداخته شده است. یافته‌ها: بر اساس بررسی متون انجام شده در نگاه مکتب طب سنتی ایران تب می‌تواند ریشه در اختلالات دیگر اعضای بدن داشته باشد که در تشخیص بیماری‌ها کمک کننده است. همچنین انواع تب در طب سنتی ایران عبارت بودند از تب سودایی، تب دموی، تب روزانه، تب خلطی و انواع دیگر بودند. همچنین طب سنتی به معاینه دقیق بیمار و هر آنچه مربوط به بروز قبل از تب بوده توجه خاص داشته و بسیاری از درمان‌های غذایی تجویزی با موازین پزشکی نوین همخوانی داشته است. نتیجه‌گیری: با توجه به اینکه در طب نوین بسیاری از موارد تب به صورت ناشناخته باقی مانده و در اقدامات تشخیصی جوابی حاصل نمی‌گردد توجهی جدید به دیدگاه تشخیصی و درمانی اطبا سنتی می‌تواند بخشی از نارسایی طب نوین را ترمیم و قابلیت پاسخگویی آن را ارتقا داد.&nbsp

Antibiotic Susceptibility of Brucella Melitensis in Markazi Province (2014)

Abstract Background: Brucellosis is one of the most important diseases among humans and animals. Clinical management of brucellosis due to an increased rate of treatment failure and recurrence is extremely worrying. The aim of this study was to determine the antimicrobial susceptibility pattern of the brucella isolates. Materials and Methods: From April to September 2014 a total of 30 brucella isolates that were cultured on brucella agar has been studied. The species identification was carried out and to determine the effect of antibiotics on bacteria antibiogram testing was performed by disk diffusion. Results: In this study, 30 brucella strains were isolated from cultured specimens and antibiogram testing was performed. All microbial positive specimens were sequenced by PCR. All isolates were Brucella melitensis. According to the tests, suceptibility to tetracycline, minocycline, gentamicin, tigecyclin was 100%, to doxycycline 93.3%, co-amoxiclave 66.7%, rifampin 44.7%, streptomycin 86.7%, ciprofloxacin 80%, cotrimoxazole 76.7% and ceftriaxone 73.3%. Conclusion: This study shows that the predominant strain in our patients was Brucella melitensis. Also, due to high levels of resistance to rifampin to use the other effective drugs like gentamicin, streptomycin, ciprofloxacin or cotrimoxazole in combination with doxycycline or tetracycline

بررسی وضعیت بهداشتی و پزشکی دوره قاجار از دیدگاه سفرنامه‌نویسان

Background and Aim: Iran is among the countries that has been the destination of many travelers especially in the nineteenth and early twentieth century. Therfore the aim of this study to investigating the Health and Medical Status of the Qajar Period from the Point of View of Travel Writers. Materials and Methods: This is a review through access to reliable sources in the form of an article descriptive Health and Medical Status of the Qajar Period from the Point of View of Travel Writers Using the appropriate keywords including "Qajar", "Travel Writers", "Health" and electronic search in SIDs, Google scholar, Pubmed and hand search in credible sources of library information, and focused on the research goal of the study of health and medical status during the Qajar period. Findings: In general, the angle of view of internal observers and foreign travelers in relation to health (prevention and treatment of diseases, public health) in Qajar is influenced by traditional religious beliefs and in most current travel logs the medicine and public health status in terms of drinking water, Bathing, treating illnesses, the health status of passages and personal health of Iranians during the Qajar period was not appropriate. Conclusion: The travelers who wrote their memoirs on the trip to Iran during the Qajar period provided a clear picture of the social situation, administrative organization, traditions and traditions of the Iranian people of that time. These travelogues are one of the most important historical and anthropological sources that provide us with useful information about Iranian culture and history of that period.   Please cite this article as: Khodarezaye A, Mahmoodi SA, Motevali A, Farazi AA. Investigating the Health and Medical Status of the Qajar Period from the Point of View of Travel Writers. Med Hist J 2019; 11(39): 15-30.زمینه و هدف: ایران از جمله کشورهایی بوده که به خصوص در قرن نوزدهم و اوایل قرن بیستم مقصد بسیاری از سیاحان بوده است. در پژوهش حاضر سعی بر آن شده تا وضعیت بهداشت و پزشكی ایران از دیدگاه سیاحان آن دوره مورد ارزیابی قرار گیرد. مواد و روش‌ها: در این مطالعه مروری توصیفی سعی شده است از طریق دسترسی به منابع معتبر وضعیت بهداشتی و پزشکی ایران در دوران قاجار مورد بررسی قرار گیرد. جهت این کار با استفاده از واژگان کلیدی مناسب از جمله «قاجاریه»، «سفرنامه‌نویسان»، «بهداشت» و جستجوی الکترونیکی در بانک‌های اطلاعاتی SID، Google Scholar، Pubmed و جستجوی دستی در منابع معتبر کتابخانه‌ای اطلاعات گرداوری و به هدف محوری پژوهش که بررسی وضعیت بهداشتی و پزشکی در دوران قاجار پرداخته شده است. یافته‌ها: سیاحانی که خاطرات خود از سفر به ایران در دوره قاجار را به نگارش درآوردند، تصویر روشنی از اوضاع اجتماعی، تشکیلات اداری، آداب و رسوم و سنن ایرانیان آن زمان ارائه داده‌اند. بر اساس منابع یافت‌شده در اکثر سفرنامه‌های موجود وضعیت پزشکی و بهداشت عمومی از لحاظ آب آشامیدنی، استحمام، درمان بیماری‌ها، وضعیت بهداشتی معابر و بهداشت فردی ایرانیان در زمان قاجار مناسب نبوده است. نتیجه‌گیری: طورکلی زاویه دید ناظران داخلی و مسافران خارجی نسبت به وضعیت سلامت (پیشگیری و درمان بیماری‌ها، بهداشت عمومی) در ایران قاجار متأثر از جامعه سنتی معتقد به ارزش‌های مذهبی بوده و در مجموع نشانگر وضعیت نامناسب بهداشتی در اکثر زمینه‌ها بوده است

Comparison the prevalence of isolated Hepatitis B core antibody among injection drug users with blood donors in central province in IRAN

Background: In healthy blood donors, 2%–5% have isolated anti-HBc. Prevalence of hepatitis B, C and co- infection (HBV +HCV) among injection drug user is high. Hepatitis C suppress of HB SAg and may be hepatitis B presented only with isolated anti HBC. This study determined of prevalence of isolated anti HBC among injection drug users and compare with blood donors in Arak city. Methods: A total 684 subjects (531voluntary blood donors and 153 injection drug users) in Arak, Iran were included in this study. Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), anti-HBc, and hepatitis C antibody (anti-HCV) were tested in all subjects. Results: A total of 531 voluntary blood donors living in the city of Arak, in the Central Province of Iran, with a mean age of 36 ± 10.18 years (range 16–60 years) were enrolled in the study. Ninety-three percent of patients were male and 7% were female. Of the 531 cases, 11 subjects (2.1%) had isolated anti-HBc. A total of 153 injection drug users of Arak, in the Central Province of Iran, with a mean age of 30.66 ± 5.92 years (range 20-50 years) were enrolled in the study. All of them were male. Of the 153 cases, 12 subjects (7.84%) had isolated anti-HBc. All of 12 cases were HCV positive. Conclusion: Prevalence of isolated anti-HBc among injection drug users was 3. 73 fold in comparison with blood donors. For diagnosis of hepatitis B in this group test for anti-HBc will be done. Evaluation of occult hepatitis B in subject with isolated anti-HBc by exact method such as real time PCR is necessary

Serological response to one intradermal or intramuscular hepatitis B virus vaccine booster dose in human immunodeficiency virus-infected nonresponders to standard vaccination

Purpose : Hepatitis B virus (HBV) vaccination is recommended for all human immunodeficiency virus (HIV)-infected patients without HBV immunity. However, serological response to standard HBV vaccination is frequently suboptimal in this population and the appropriate strategy for revaccination of HIV-infected nonresponders remained controversial. We aimed to determine the serological response to one booster dose of HBV vaccine given by intradermal (ID) or intramuscular (IM) route in HIV-positive nonresponders to standard HBV vaccination. Materials and Methods : In this study, 42 HIV-infected nonresponders were enrolled. We randomized them to receive either 10 μg (0.5 mL) for ID (20 cases) or 20 μg (1 mL) for IM (22 cases) administration of HBV vaccine as a one booster dose. After 1 month, anti-HBs titer was checked in all cases. A protective antibody response (seroconversion) defined as an anti-HBs titer ≥10 IU/L. Results: Seroconversion was observed in 47.6% of subjects after 1 ID dose. A total of 30% showed antibody titers above 100 IU/L. Except one case, all responders had CD4 + >200 cells/mm 3 . Mean anti-HBs titer was 146.5 ± 246 IU/L. After the one IM booster dose, seroconversion was observed in 50% of cases. A total of 36.3% of subjects had anti-HBs ≥100 IU/L. All responders had CD4 + >200 cells/mm 3 , except one case. Mean anti-HBs titer was 416.4 ± 765.6 IU/L. Responders showed significantly higher CD4 + cell counts, in comparison to nonresponders (P < 0.001). Conclusions: One booster dose administered IM or ID to HIV-infected nonresponders resulted in similar rates of seroconversion, overall response rate 50%. However, higher anti-HBs titers observed more frequently in IM group

Extensive Genetic Diversity among Clinical Isolates of Mycobacterium tuberculosis in Central Province of Iran

Human tuberculosis caused by Mycobacterium tuberculosis (Mtb) remains a significant disease in many countries. According to Iran’s borders with Afghanistan and Pakistan, which are among the 22 high burden countries around the world, this study was conducted to analyze the current molecular epidemiology of tuberculosis and survey genetic diversity of Mtb strains in Markazi Province in center of Iran. In this experimental study, 75 sputum specimens and one gastric lavage from all smear-positive TB patients admitted to the public hospitals across the Markazi Province were cultured on specific mycobacterial culture media. Genomic DNA was digested by PvuII and transferred to positively charged nylon membrane by southern blotting method and hybridization by PGRS and DR probes. Genotyping of the isolates by PGRS-RFLP and DR-RFLP displayed a wide range of genetic diversity as 25 and 26 genotypes were identified, respectively. Generally speaking, despite the relatively limited number of isolates in the study, high age of patients and also large heterogeneity found in the setting are both in opposition to active circulation of Mtb strains between patients under study either Iranian or Afghan nationals. Thus, it seems that reactivation of latent infection has had the main role in the spread of tuberculosis

Antimycobacterial activity assessment of three ethnobotanical plants against Mycobacterium Tuberculosis: An In Vitro study

Objective/Background: Resistances to herbal medicines are still not defined and finding natural remedies against drug resistant Mycobacterium tuberculosis (MTB) has research priority. The antimycobacterial susceptibility method for herbal extracts is unclearly defined and there is no standard method for assessment of the materials against bacteria. In the present study, time kill of three medicinal plants was determined against MTB. Methods: The clinical isolate of MTB from a patient who harbored confirmed tuberculosis was used in the study. Aqueous extracts of Aloe vera leaves, mint, and Hypericum perforatum were prepared using reflux distillation. Disk diffusion methods were conducted in Petri dishes and McCartney bottles containing Löwenstein–Jensen medium to measure the sensitivity of plant extracts in serial concentrations of 0.25–8 mg/mL. A pour plate method was performed by mixing 0.7 mL of each concentration of extract in 5 mL Löwenstein–Jensen medium followed by surface culturing of MTB fresh cells. The time kill method was conducted by bacterial suspension in equal amounts of the extract and viable evaluation in fresh culture at the beginning, and at 24-h, 48-h, 72-h, and 1-week intervals. All cultures were incubated at 37°C for 4 weeks. Inoculum concentrations were considered as a variable. Results: The zones of inhibition of A. vera, H. perforatum, and mint extracts in the disk diffusion method in McCartney bottles were 60 mm, 41 mm, and zero, respectively, but Petri dishes did not have repeatable results. In the pour plate method, an extract concentration up to 1 mg/mL could inhibit cell growth. In mint extract, colony forming was four times more than the others at 0.5 mg/mL. Time kill of 95% of cells occurred when exposed to extracts of A. vera and H. perforatum separately, but was 50% in 24 h and 20% in 10 min. The time kill for mint was 95% in 1week. Conclusion: The results give some scientific basis to the use of plant extracts for growth control of MTB cells. Clinical trials are recommended for assessment of the extract as complementary medicine, as well as for antisepsis

Molecular typing of Mycobacterium tuberculosis strains isolated from patients in Markazi Province

Background: RFLP-IS6110 standard technique to genotyping M. tuberculosis.The aims of this study were to identify the genetic diversity of M. tuberculosis population in Markazi province and to recognize the mode of disease transmission in this region. Material and Methods: The RFLP results of 42 isolates of M. tuberculosis deposited in the Mycobacterial Centre from Markazi province were analyzed. DNAs isolated from these isolates were enzyme digested with Pvu II, and hybridized with a PCR amplified DIG-labeled IS6110 probe. Results: The isolates were classified into four groups, based on the copy numbers, as follows: (1) lacking IS6110 element (2) low copy numbers (1-2) (3) intermediate copy numbers (3-5) and (4) high copy number (6-17). Copy numbers higher than 17 however were not observed in any of the isolates studied, 72 percent of the isolates showed high copy numbers of IS6110, 13 percent intermediate copy numbers, 10 percent low copy numbers, whereas 5 percent isolates lacked IS6110 element. Conclusion: IS6110 DNA fingerprinting assisted us to find epidemiological links between some TB cases, and this technique estimates from reactivation of latent infection transmission of the disease in Markazi province. The low rate of clustering indicates that tuberculosis among studied population is resulted mainly from reactivation of latent infection in this region