Nasopharyngeal Colonization and levofloxacin Susceptibility of Streptococcus pneumoniae among Healthcare Workers in a Teaching Hospital in Tehran, Iran

Background: Streptococcus pneumoniae commonly asymptomatically colonizes the human upper respiratory tract and the carriage rate varies between geographical regions. The colonized individuals are not only at risk of infections but also can be a source of transmission of the pathogen. The risk of the droplet or airborne transmission of pneumococcal strains healthcare workers is considerable.  The current study aimed to determine the extent of nasopharyngeal colonization with S. pneumoniae and their levofloxacin susceptibility at a tertiary hospital in Tehran, Iran. Materials and Methods: During a six-month period, the nasopharyngeal swab samples collected from 300 volunteer healthcare workers of Imam Hossein Hospital. Samples screened for S. pneumoniae using standard conventional biochemical methods. The minimum inhibitory concentration (MIC) of levofloxacin was determined using a commercially available strip antibiotic test according to the clinical laboratory standards institute (CLSI) guidelines. Results: A total of 19 (6.3%) enrolled healthcare workers were colonized with S. pneumoniae. Amongst the enrolled volunteers, nurses had a higher rate of pneumococcal colonization (47.3%) followed by interns (21%) and laboratory workers (15.8%). Our analysis revealed that there was a significant correlation between smoking and pneumococcal colonization. The antimicrobial susceptibility testing showed that all of the isolates were susceptible to levofloxacin (MIC≤2 μg/ml). Conclusion: This low rate of pneumococcal colonization amongst healthcare professionals may be attributed to the low risk of horizontal transmission of severe pneumococcal infections in the hospital. Additionally, our findings indicated that levofloxacin was an effective antimicrobial agent for the treatment of pneumococcal infections

Role of Prophylactic Antibiotic Administration in Growth of Methicillin Resistant Staphylococcus Aureus in Rhinoplasty

Background: Septoplasty and septorhinoplasty are common surgical procedures in modern surgical practice. Pre or postoperative antibiotic administration has raised concerns about the possible increase in the antibiotic-resistant species. The aim of this study was to evaluate the role of postoperative antibiotic prophylaxis in increasing Methicillin-Resistant Staphylococcus Aaureus species (MRSA) in patients, who underwent septoplasty or septorhinoplasty in Loghman Hakim Hospital in Tehran, Iran.Methods: A total of 102 patients, who were planned to undergo septoplasty or septorhinoplasty, participated in this double-blind randomized clinical trial. The patients were divided into the case (n=60, mean age of 28.2 years) and control (n=38, mean age of 28.9 years) groups. Overall, 98 patients participated in the study. The case group received a preoperative injection of cephalothin (1g) and postoperative oral cephalexin regimen (500mg 4 times a day for 7 days). The control group only received a preoperative injection of cephalothin (1g). Vestibular nasal swab cultures were obtained preoperatively and on postoperative day 7. The samples were, then, quickly transferred to the laboratory and cultured on proper media. The results indicated that five MRSA species in the case group and tow MRSA species in the control group were present, postoperatively.Results: The findings of this study suggest that oral antibiotic prophylaxis may lead to a statically non-significant increase in MRSA infection in patients, who require this treatment. Conclusion: Further knowledge of the endogenous nasal flora and the microbiology of common pathogens in patients undergoing septorhinoplasty will help reduce the incidence of infectious complications to a greater level

Echocardiographic Findings of ICU-Admitted COVID-19 Patients: a Multicenter Retrospective Study

Background: The coronavirus disease 2019 (COVID-19) pandemic has left many victims and caused many problems for the healthcare systems of different countries. Many COVID-19 patients have cardiovascular complications, which are detectable using echocardiography. This study aimed to determine the echocardiographic findings and their association with mortality in an intensive care unit (ICU)-admitted COVID-19 patients. Materials and Methods: In this retrospective study, COVID-19 patients admitted to the ICU of four hospitals in Tehran, Iran, from April 2020 to March 2021 were recruited. Data were collected by the census method. We reviewed the medical records regarding demographic features, clinical history, laboratory results, and echocardiographic findings. Finally, variables were compared regarding disease outcomes at the end of hospitalization. We used the Chi-square test, Fisher’s exact test, independent-samples t-test, and logistic regression model to analyze the data. Results: This study showed that the mean age of 629 COVID-19 patients was 66.42±14.53 years. Overall, 56.8% of the patients were male. Multivariate regression analysis showed that age (OR=1.03; 95% CI: 1.01-1.05), left ventricular ejection fraction (OR=0.95; 95% CI: 0.92-0.98), and systolic pulmonary arterial pressure (OR=1.12; 95% CI: 1.06-1.18) were predictors of mortality. Conclusion: Cardiovascular involvement is prevalent among critically ill COVID-19 patients. Among echocardiographic findings, EF and s-PAP were significantly associated with the disease outcomes

Bacterial Infection of Pacemaker in Patients with Endocarditis

Background: The advancement of technology in recent decades has been lead to use the electrophysiology cardiac devices. Although these devices are used increasingly, but the frequency of subclinical infection is unknown. We investigate bacterial infections due to implantable cardioverter defibrillator (ICDs) in patients with endocarditis.Materials and Methods: Population of the study was considered among all adult patients in whom the cardiac electrophysiology device was removed. Associated infection endocarditis defined by the Duke criteria. 35 pacemakers (PM) were aseptically removed from these patients during January 2012 to November 2014. Intraoperative swabs from the different part of devices were collected, cultured in BHI (Brain Heart Infusion Broth) and then bacterial classical cultures were done under aerobic and anaerobic conditions. Biochemical and differential media were used to detect the bacteria species. Data analysis was performed by using SPSS version 16 software.Results: 13 cases of 35 patients with endocarditis diagnosed by modified Duke Criteria and removed pacemaker had positive culture. Of the 13 cases with infection 43% were identified as gram positive and 57% had gram negative bacteria.Conclusion: Based on our study and similar studies, bacteria can colonize in electrophysiology devices which can lead to bacterial infections.

The evaluation level of carboxyhemoglobin in children blood with chief complain of headache, nausea, and dizziness referring to pediatric clinics of Loghman hakim hospital in year 2018-2019

Carbon monoxide poisoning is common, challenging and serious poisoning with wide range of non-specific flu-like clinical manifestations that leads to misdiagnosis. This cross-sectional descriptive controlled study conducted in Loghman Hakim Hospital on 3-14 year-old patients presenting with non-specific Flu-like (headache, dizziness, nausea, vomiting, malaise) symptoms from November 2018 to May2019. In all subjects carboxyhemoglobin level measured via noninvasive pulse CO-oximetry (Massimo Company, USA). Demographic data, cigarette, shisha, opium smoke exposure, type of home heater, carboxyhemoglobin level were collected and statistically analyzed via SPSS v16.0. A total of 93 children 3-14 year-old were enrolled the study. Their mean age was 4.6+4.3 years, 46% were male and54% female. Mean carboxyhemoglobin level was 27.8+9.7 %( range 2.7% to 44%). The most frequently encountered symptoms were nausea &vomiting (44%), dizziness (36%), headache (32%) and myalgia (23%). We obtained the COHb levels using noninvasive pulse oximeter for all study patients and their mother, and the levels > 5% for non-smokers were considered as CO poisoning. Of the 93 study patients, 49%had normal carboxyhemoglobin levels (CoHb level< 5%). Of the remaining 51% study patients, 47 patients had CoHb levels between 5% and 10%, and seven patients > 10%. Closer attention to early and nonspecific signs and symptoms of Carbon Monoxide poisoning and higher clinical suspicion could reduce the rate of misdiagnosis and therefore minimize complications in this serious poisoning

Hepatitis E virus infection in hemodialysis patients: A seroepidemiological survey in Iran

BACKGROUND: The hepatitis E virus (HEV) has a global distribution and is known to have caused large waterborne epidemics of icteric hepatitis. Transmission is generally via the fecal-oral route. Some reports have suggested parenteral transmission of HEV. Anti-HEV prevalence data among chronic hemodialysis (HD) patients are few and give conflicting results. METHODS: This cross-sectional study was conducted in August of 2004. We tested 324 chronic HD patients attending three different units in the city of Tabriz, northwestern part of Iran, for anti-HEV antibody. A specific solid- phase enzyme-linked immunoassay (Diapro, Italy) was used. RESULTS: The overall seroprevalence of hepatitis E was 7.4 %(95% CI: 4.6%–10.6%). The prevalence rate of HBV and HCV infection were 4.6% (95% CI: 2.3%–6.9%) and 20.4% (95% CI: 16%–24.8%), respectively. No significant association was found between anti-HEV positivity and age, sex, duration of hemodialysis, positivity for hepatitis B or C virus infection markers and history of transfusion. CONCLUSION: We observed high anti-HEV antibody prevalence; there was no association between HEV and blood borne infections (HBV, HCV, and HIV) in our HD patients. This is the first report concerning seroepidemiology of HEV infection in a large group of chronic HD individuals in Iran

The Correlation between Serum Level of N-Terminal Pro-B-type Natriuretic Peptide and Gensini Score in Patients with Acute Coronary Syndrome

Introduction: N-terminal pro-B-type natriuretic peptide (NT-proBNP) has emerged as an important biomarker for developing the diagnosis and prognosis of cardiovascular diseases, as several studies have shown that serum levels of NT-proBNP elevate in acute coronary syndrome (ACS) and coronary artery disease (CAD). We performed this study to find any possible correlation between serum levels of NT-proBNP and Gensini score in patients diagnosed with ACS.Methods: In a cross-sectional study, 100 consecutive patients with ACS who were candidates of angiography were recruited and their serum levels of NT-proBNP, Gensini scores, lipid profiles and troponin I levels were measured.Results: Sixty six male and 34 female patients with a mean age of 57.5 years, including 44 with unstable angina, 33 with ST-elevation myocardial infarction, and 23 with non-ST-elevation myocardial infarction were enrolled. The mean serum NT-proBNP level and the Gensini score were 1987.16 pg/mL (17.9-8841) and 31.09 (6-92.5), respectively. The serum NT-proBNP levels and Gensini scores were significantly correlated with a Spearman correlation coefficient of 0.953 (P < 0.001). Serum levels of NT-proBNP were not different in patients with single-vessel disease, 2-vessel disease and 3-vessel disease (P = 0.257). NT-Pro-BNP levels were also correlated positively with troponin I levels (correlation coefficient = 0.779) and negatively with left ventricular ejection fraction (correlation coefficient = -0.55). Smoker patients had higher NT-proBNP levels (P = 0.047). Neither Gensini scores nor NT-Pro-BNP levels had significant correlation with lipid profile or blood sugar.Conclusions: NT-proBNP is directly correlated with Gensini score in patients with ACS and might be used as an important marker for risk stratification in those patients

Investigating the Genetic Characteristics of Cochlear Implant Candidates with Hearing Impairment

Background: Hearing loss, especially at a young age, has severe personal and social consequences for a person and brings enormous costs to the treatment system. Considering the vital role of genetics in hearing loss, genetics research creates a suitable platform for progress in the treatment of these patients, so we decided to conduct a study with the aim of early diagnosis and even before symptoms appear in order to reduce possible complications. Aim: In this study early diagnosis of hearing loss and even before symptoms appear in order to reduce possible complications. Methods: Based on the history and phenotype and examination of the medical records of 1249 patients who are candidates for cochlear implantation, genetic testing among the patients suspected of non-syndromic genetic hearing loss, a request for genetic testing of stage one or two or both was made and according to the willingness of the families and their cooperation A total of 138 genetic tests were performed and subjected to genetic analysis. Results: Among 138 tested cases, 71 women and 67 men, NSHL inheritance autosomal recessive pattern was 84/78% and autosomal dominant, 5/07 which is very close to previous studies. There were genetic mutations in the Gjb2 gene in ten cases of patients. Ninety-one patients were negative for GJB2 involvement and were candidates for WES, but unfortunately, many families refused to perform the test due to the cost of this test. Seven patients underwent WES, and several genetic mutations were identified in the thesis. WES was performed for 34 patients according to the investigations carried out directly. Conclusion: Iranian society has played an essential role in improving our understanding of the genes involved in proper hearing functioning and how these genes' variants cause hearing loss. Researchers have worked tirelessly to solve the genetic mystery of hearing loss in Iran, which has been very successful. However, more work is still needed

Comparison of Mono and Biphasic Culture Media in Isolating Bacteria from Blood and evaluation Bu-Ali Hospital Lab Quality

    Blood Culture is an important diagnostic method in infectious diseases and has positive results in 30%- 50% and even to 80% of cases due to sample volume. In Bu-Ali Hospital, Tehran, it decreases to 2-3%. In this survey, quality of hospital lab and difference between Mono and Biphasic culture media in isolating bacteria from blood of patients suggestive of sepsis were evaluated.106 (48 F + 58 M) newly admitted patients with impression of sepsis as SIRS (Systemic Inflammatory Response Syndrome) (36˚C >OT>38.3˚C , tachycardia more than 100/min, leukocytosis  with shift  to left or leucopenia) with infectious source were sampled for culture (5ml blood 3 times in 1 Biphasic and 2 Monophasic media) in the infectious ward. One Monophasic Media in hospital lab and the two other (1 Monophasic + 1 Biphasic Media) in Reference Laboratory of Iran, Research Center were handled. Media were quality-controlled at beginning and in the middle of study by NCCLS (National Committee for Clinical Lab Standard) with ATCC (American Type Culture Collection) samples. Sampling, transfer, and handling were all in standard conditions usually used in hospital. Results were compared by Fisher Exact Test. Clinical diagnosis were bacterial in 84 (79%), and nonbacterial in 22 (21%) patients at admission. 57 (54%) patients had not used antibiotics in the past 72 hours. In Monophasic Media of hospital lab 2 (1.9%) positive cultures (S. epidermidis) one with history of Erythromycin use were reported. In both Monophasic and Biphasic Media in reference lab 3 (2.8%) positive cultures (2 S.epidermidis, 1 E. coli) were reported equally, one with history of Erythromycin use. Growth Index in both Monophasic and Biphasic Media were standard in quality control. Qualities of Mono and Biphasic Media in growing bacteria were alike and Biphasic Media had no superiority to Monophasic Media in routine bacterial isolation. Positive culture in both labs had no significant statistical difference. So, negative results are not due to media and laboratorial fields, and it is needed to educate and evaluate two other fields: Sampling and Transferring. Also, we may have more positive cultures by increasing blood samples from 5 to 20 ml which can be compared in next studies