A Potential Role of Cytomegalovirus Reactivation in the Severity of COVID-19 in the Elderly

In late 2019, severe acute respiratory syndrome- coronavirus-2 (SARS-CoV-2) was reported in Wuhan, China. This virus spread quickly worldwide, with millions of victims until now. The clinical manifestations of the novel coronavirus disease (COVID-19) are a broad spectrum, from asymptomatic and mild cases with a flu-like syndrome to severe cases requiring intensive care1. The severity of diseases and risk of mortality is higher in the elderly, which most authorities attribute to underlying conditions, including diabetes, hypertension, cardiovascular diseases, and respiratory diseases. However, some neglected factors, such as cytomegalovirus (CMV) reactivation, can affect patient outcomes2

Impact of an Antimicrobial Stewardship Program on the Frequency of Drug resistant Bacteria in an Intensive Care Unit

Background: One of the major health problems in the intensive care unit (ICU) is the nosocomial infection caused by multidrug-resistant (MDR) pathogens. The antimicrobial stewardship program (ASP) is a solution to prevent antibiotic resistance. This study aimed to determine the impact of an antimicrobial stewardship program on the frequency of drug-resistant bacteria in an ICU.Materials and Methods: This quasi-experimental study was conducted between 2019 and 2021 in Labbafinejad Hospital, Tehran, Iran. This study consisted of two time periods: 1) one year with no restriction of antibiotic prescription (before ASP), and 2) one year with restriction of antibiotic prescription based on the stewardship program (after ASP). We obtained demographic and clinical characteristics of patients from their medical records. Standard disk diffusion and broth microdilution were used to determine the antibiotic susceptibility of bacterial pathogens isolated from the patients.Results: A total of 300 ICU-admitted patients were included in the study (150 for each period). We found out that the total length of hospitalization, length of hospitalization in ICU, and treatment duration were lower after ASP (P=0.022, P=0.383, and P<0.001, respectively). Also, the frequency of antibiotic resistance, including MDR and Vancomycin-Resistant Enterococci (VRE) strains, decreased significantly after performing ASP (P=0.013). However, in terms of mortality, there was no significant difference between the two periods (P=0.236).Conclusion: The results of our study highlight the implementation of the antibiotic Stewardship program and the rational use of antibiotics in the ICU setting to inhibit the spread of antibiotic-resistant bacteria

Detection of Carbapenems and Colistin Resistance Genes in Pseudomonas aeruginosa and Acinetobacter baumannii: A Single-center Study in Iran

Background: This study aimed to determine carbapenems, colistin resistance genes, and antimicrobial susceptibility profiles of Pseudomonas aeruginosa and Acinetobacter baumannii isolates.Materials and Methods: In this cross-sectional study, specimens of patients with bloodstream, urinary tract, and surgical site nosocomial infections were enrolled. P. aeruginosa and A. baumannii isolates were identified using conventional methods. Antimicrobial susceptibility testing (AST) on isolates was performed using the disk diffusion method and minimum inhibitory concentration (MIC) for colistin as recommended by the Clinical and Laboratory Standards Institute (CLSI). The combination meropenem disk method was used to detect metallo-β-lactamases (MBLs). The blaNDM, blaVIM, blaIMP, and mcr-1 genes were identified using the polymerase chain reaction (PCR) method and Sequencing.Results: Forty strains of P. aeruginosa and forty strains of A. baumannii were isolated from hospitalized patients. The overall prevalence of multidrug-resistance (MDR) was 50% and 95% in P. aeruginosa and A. baumannii isolates, respectively. Almost all the MDR isolates were resistant to cefepime and piperacillin. Colistin had significant inhibitory activity against the isolates. MBL was detected in 25.0% and 15.0% of clinical isolates of P. aeruginosa and A. baumannii, respectively. We detected no blaNDM, blaVIM, blaIMP, and mcr-1 genes in our A. baumannii isolates. Moreover, only three P. aeruginosa isolates were positive for blaIMP gene.Conclusion: The alarming proportion of MDR P. aeruginosa and A. baumannii isolates was reported in the current study. Effective infection prevention practices are required and AST should guide patients' treatment

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

Impact of an Antimicrobial Stewardship Program on the Frequency of Drug resistant Bacteria in an Intensive Care Unit

Background: One of the major health problems in the intensive care unit (ICU) is the nosocomial infection caused by multidrug-resistant (MDR) pathogens. The antimicrobial stewardship program (ASP) is a solution to prevent antibiotic resistance. This study aimed to determine the impact of an antimicrobial stewardship program on the frequency of drug-resistant bacteria in an ICU. Materials and Methods: This quasi-experimental study was conducted between 2019 and 2021 in Labbafinejad Hospital, Tehran, Iran. This study consisted of two time periods: 1) one year with no restriction of antibiotic prescription (before ASP), and 2) one year with restriction of antibiotic prescription based on the stewardship program (after ASP). We obtained demographic and clinical characteristics of patients from their medical records. Standard disk diffusion and broth microdilution were used to determine the antibiotic susceptibility of bacterial pathogens isolated from the patients. Results: A total of 300 ICU-admitted patients were included in the study (150 for each period). We found out that the total length of hospitalization, length of hospitalization in ICU, and treatment duration were lower after ASP (P=0.022, P=0.383, and P<0.001, respectively). Also, the frequency of antibiotic resistance, including MDR and Vancomycin-Resistant Enterococci (VRE) strains, decreased significantly after performing ASP (P=0.013). However, in terms of mortality, there was no significant difference between the two periods (P=0.236). Conclusion: The results of our study highlight the implementation of the antibiotic Stewardship program and the rational use of antibiotics in the ICU setting to inhibit the spread of antibiotic-resistant bacteria

Assessing Attitudes of Medical Students towards First Contact with Patient in Tehran (2016-17)

Background: Early experience of clinical arena as first situations can be effective in selection or refusing medicine as profession is so important that programmers and administrators should consider these settings as one of the most elements in educational programs.Materials and Methods: This study was a cross-sectional study and including presently studying students in medicine field of medical sciences universities. Sample size was estimated for 275 students. Participants were selected from schools of medicine: Iran University (IUMS), Shahid Beheshti University, and Islamic Azad University using stratified random sampling method. Data was collected in March of 2016 by a researcher made questionnaire determined its validity and reliability. Data was analyzed using chi-squared test, t-test, Mann-Whitney and Kruskal-Wallis test.Results: Mean score of medical students’ attitude from 15 five-degree scale questions was 51.22 ± 6.32. The mean scores of attitude in men and women were 51.37±6.16 and 51.06±6.53, respectively (p=0.687). Overall, 13.8 % of students had positive attitude towards first contact with patient, 10.5 % of students had negative attitude and 75.6 % had no opinion. The mean scores of attitude towards first contact with patient in Iran university, Shahid Beheshti university and Islamic Azad university were 50.40±5.00, 52.71±5.91 and 46.12±5.97, respectively (p&lt;0.001). The mean scores of attitude towards first contact with patient in reformed educational system and old educational system were 52.35±5.83 and 46.12±5.97 respectively, with a significant difference between two types of educational system (p&lt;0.001).Conclusion: As respects more positive attitude of students in reformed educational system in comparison with old educational system, special attention to courses of early contact with patient may contribute to decreasing educational insufficiency and distance between theory and practice and lead to the satisfaction all of beneficiaries

Efficiency of Microalgae Chlamydomonas on the Removal of Pollutants from Palm Oil Mill Effluent (POME)

AbstractMalaysia is considered as a major palm oil producer in the world. Therefore, it is vital to utilize an environmentally friendly and inexpensive method to treat palm oil mill effluent (POME) in Malaysia. Nowadays, the use of microalgae to remove pollutants from POME has gained a lot of attention. The main objective of this research was to investigate the effect of POME as a nutrient on the microalgae growth and analyze the removal rate of pollution. In this study, a pure culture Chlamydomonas incerta was aseptically transferred to an Erlenmeyer flask containing POME. The effect of POME as a high nutritional substrate, different cultivation scales, carbon total nitrogen (C:TN) ratio, and the lipid productivity of microalgae C. incerta were assessed. C. incerta was grown at room temperature under continuous illumination with the intensity of ± 15 (μmol/m2/s) for 28 days, followed by the measurement of chemical oxygen demand (COD) reduction at different substrate concentrations. The results of this study demonstrated that organic carbon was removed by C. incerta for the ratio of 100:7, 100:13, and 100:31 respectively within the second day of cultivation. Fast growth of microalgae was observed in organic and inorganic substrates for adoption within the second day of experiment. The optimum achievement rate of nutrient removal with C. incerta was about 67.35% of COD for 250mg/L of POME concentrations in 28 days. The significance of this study is regarding the introduction of a new microalgae strain with a high ability to remove nutrients from POME, which can contribute to the effort in finding an efficient and economic technology for improving our environment

A novel taxanomy on self-healing concrete research development

Self-healing concrete has beenwidely recognized as remedial technique to improve the durability of concrete.Some review papers have been published on self-healing concrete. Yet thehierarchical structure foritsclassificationneeds to be reviewed. This study presents a novel taxonomy making use of advances inknowledgefor self-healing concrete. The study addresses the general taxonomy of self-healing concrete to beclassified into three categories i.e., natural, chemical and biological processes. The focus is on the study ofthe biological processes.The review and taxonomy presents a new insight into the research on treatment ofunexpected cracking of concrete. The information presented in this paper is significant for biotechnologistsand bioprocess engineers to have comprehensive updates on the current status-quo ofself-healing concrete

A Randomized Controlled Trial: Colistin Alone or Colistin and Meropenem: Which Is More Effective for the Management of Urinary Tract Infections? Colistin with and without Meropenem for Management of Urinary Tract Infections

Background: Colistin is a common antibiotic used to treat urinary tract infections (UTIs) caused by gramnegative bacteria. In recent years, due to the increasing resistance, consumption of colistin alone could lead totreatment failures. This study aimed to compare the effectiveness of colistin alone with colistin and meropenemto treat patients with urinary tract infections.Materials and Methods: In this randomized, open-label, parallel groups controlled trial, hospitalized patientswith urinary tract infections were included. Patients were randomly allocated to the control group (n=35) thatreceived colistin (1 mIU every 12 hours) and the intervention group (n=35) that received colistin (1 mIU every12 hours) with meropenem (1gr every 8 hours). An infectious disease specialist evaluated the therapeuticresponses 48-72 hours after admission. Cessation of fever, improvement of symptoms and signs, and negativeurine culture within 48 hours were considered successful therapeutic responses.Results: The mean length of hospitalization was longer in the control group (4.74±0.78 days) compared withthe intervention group (4.26±0.56 days) (P=0.004). The prevalence of fever cessation had no significantdifference between the two groups at any time (P&gt;0.05). Also, there was no significant difference betweenthe two groups at any time, considering vital signs, irritative urinary symptoms, nausea and vomiting, andflank pain (P&gt;0.05).Conclusion: The administration of colistin and meropenem to treat UTIs was associated with a shorterlength of hospital stay. However, regarding response to treatment, it did not matter if they were treated withcolistin alone or with combination therapy (colistin and meropenem

Psychological Effects towards Humans Living in the Environment Made of Biological Concrete in Malaysia at 2015

In day-to-day life concrete become a compulsory material in the construction field as to make it a real concern among researchers for producing concrete with improved properties. Biological method is one of the new methods to improve concrete properties. Although, much research about biological concrete has been carried out, but till now nobody has not studied for the psychological effects of using a house or offices made up of biological concrete. The aim of this study is to investigate and find out the person's opinion about staying in a house or offices made up of biological concrete. In this study, a questionnaire containing eight questions was prepared and distributed among 21 persons in Malaysia University of Technology including students, academic and non-academic staffs among which few of them was an expert in the field of biological concrete and others did not have any knowledge about the bioconcrete. Finally, the results obtained from the questionnaires were analyzed. The results showed that 81% of participants in this study would like to stay in a house or office made up of biological concrete. However, 38% of participants believe that staying in a house or office made of biological concrete can cause health related problems. The current research paper can be considered significant for architects and civil engineers to have the insight to look into the psychological aspects of using biological concrete for various applications in the field of construction