Treatment of Brucellosis

The goal of brucellosis therapy is to control the illness and prevent complications, relapses and sequelae. Important principles of brucellosis treatment include the use of antibiotics with activity in the acidic intracellular environment (doxycycline, rifampin), use of combination regimens and prolonged duration of treatment

Risk factors of HBs Ag positive in blood donors of Hamedan, Iran

Background: Viral hepatitis B is a common community acquired infection. It damages the liver tissue and can be a risk factor for cirrhosis and liver cancer. In the present study, we investigated the major risk factors for being HBs Ag positive among blood donors of Hamedan, Iran.Methods: A cross-sectional study was carried out in Hamedan city. All of the blood donors in Blood Transfusion Organization Center of the city were asked to fill out a questionnaire between September 2011 and February 2012. Logistic regression was used to calculate Odds Ratios (OR) for risk factors of being HBs Ag positive using IBM SPSS Statistics for Windows, Version 22.0.Results: Among 571 participants 119 (20.8%) were HBs Ag positive. Of all patients, 158 (27.6%) were female, 506 (88.6%) were living in urban areas. Also, 375 (65.7%) were married. Among the potential risk factors of HBs Ag positivity studied, “History of Surgery” ranked first (OR=3.11 P=0.003) and “Familial History of Liver Disease” was the second significant risk factor (OR=2.90 P=0.013). Human bite, dental filling, and needle stick had odds ratios less than one. However, they were not found to be statistically significant (P>0.05).Conclusion: Of all risk factors investigated in the present study, “History of Surgery” suggests a risk of infection transmission through surgical team. More studies on different populations are needed due to regional characteristics of hepatitis transmission

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

SummaryBackgroundCombination 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).MethodsTwo 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 100mg twice a day and rifampin 10mg/kg body weight/day every morning, both taken orally for eight weeks) or the ADR group (receiving doxycycline 100mg twice a day and rifampin 10mg/kg body weight/day every morning, both taken orally for eight weeks, plus 7.5mg/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.ResultsOf 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).ConclusionsGiven 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

Efficacy and safety of chloroquine and hydroxychloroquine for COVID-19 : A comprehensive evidence synthesis of clinical, animal, and in vitro studies

This study was financially supported by the Deputy of Research and Technology of Iran University of Medical Sciences, Tehran, Iran (Grant no. 17668).Peer reviewedPublisher PD

Nonsteroidal anti-inflammatory drugs in acute viral respiratory tract infections : An updated systematic review

Peer reviewedPublisher PD

Colistin Utilization Evaluation in a Major Teaching Hospital in Iran

Objectives: Colistin is an old antibacterial agent which is used in multiple drug resistant (MDR) infections. Due to increased rate of MDR infections, the use of this agent is raised in worldwide. The aim of this study was to identify colistin utilization patterns in a teaching hospital and to demonstrate the importance of the need to reconsider prescribing strategies for colistin administration. Methods: This retrospective cross-sectional study was performed between Augusts 2017and December 2017 at Firoozgar hospital affiliated to Iran University of Medical Sciences, Tehran, Iran. All colistin prescriptions for adult patients during the study period were enrolled for appropriateness evaluation according to the Lexi comp acquired by Wolters Kluwer and NHS guideline. Results: Among 70 patients who received colistin, pneumonia (70%) was the chief indication of colistin prescription. In 93% of cases, colistin was prescribed according to microbiological laboratory results. In 14% of patients, colistin administration was before providing microbiological laboratory evidence. Seventeen percent of the patients received loading dose of colistin. The indication of colistin therapy was inappropriate in 16% of patients.  The initial and end dose, and duration of treatment of colistin were appropriate in 20%, 40%, and 52% of patients, respectively. Among 70 cases, 24 (34%) and 36 (51%) patients required dose adjustment in first and end dose of colistin therapy which only dose correction was performed in 13 (18%) and 15 (21%) cases, respectively.    Conclusions: These findings, along with aforementioned guidelines supports the requirement for physicians’ educational programs, proper strategies for appropriate prescriptions

Seroprevalence of Immunoglobulin G antibodies against pertussis toxin among asymptomatic medical students in the west of Iran: a cross sectional study

<p>Abstract</p> <p>Background</p> <p>Pertussis is a highly communicable, vaccine-preventable respiratory infection. Immune response against this disease can be induced by infection or vaccination. Protection after childhood vaccination is minimal after ten years. Our aim was to assess pertussis immunity state in a population of healthy young medical students.</p> <p>Methods</p> <p>In this seroepidemiological survey, blood samples were obtained from 163 first-year medical students in Hamedan University, Iran. Serum level of IgG against pertussis toxin (IgG-PT) was measured by Enzyme-Linked Immunosorbent Assay (ELISA) method. For qualitative assessment, IgG-PT levels more than 24 unit (U)/ml were considered positive. Data was analysed qualitatively and quantitatively considering gender and age groups.</p> <p>Results</p> <p>There were 83 males and 80 females, with a mean age of 19.48 years, Prevalence of IgG-PT was 47.6% with mean level of 71.7 u/ml (95% confidence interval: 68.1–75.3). No statistically significant difference was observed with respect to sero-positivity of IgG-PT between males and females (45 cases (54%) vs. 34 cases (42%); P = 0.06). Mean IgG-PT levels in males and females were 84 U/ml and 58.8 U/ml, respectively (P = 0.91).</p> <p>Conclusion</p> <p>A considerable proportion of our study population with a positive history of childhood vaccination for pertussis was not serologically immune to pertussis. A booster dose of acellular pertussis vaccine may be indicated in Iranian, medical students regarding their serologic conditions and outstanding role in health care systems.</p

Mortality patterns in patients with Staphylococcus aureus bacteremia during the COVID-19 pandemic: Predictors and insights

Objectives: This paper aims to determine the Staphylococcus aureus bacteremia (SAB) in-hospital mortality rate and its associated risk factors during the COVID-19 pandemic. Methods: A total of 167 SAB samples were collected between March 2020 and March 2022 at a teaching hospital in Tehran, Iran. The patient's baseline data and antibiograms were collected. The outcome of the study was in-hospital mortality. Results: The overall in-hospital mortality rate was 41.9 %, with higher mortality observed in patients over 60 years old (P = 0.032), those with community-acquired Staphylococcus aureus bacteremia (P = 0.010), and those admitted to the ICU (P = 0.016). Antibiotic resistance profiles indicated a higher mortality in resistant S.aureus strains but only significant for ciprofloxacin (P = 0.001), methicillin (P = 0.047), and sulfamethoxazole (P = 0.023). Multivariate analysis identified age, sex, ICU admission, and the source of bacteremia as independent predictors of mortality, while COVID-19 coinfection and resistance to antibiotics were not found to be significant predictors. Conclusion: SAB remains a challenging infection that is amplified by the pandemic. Older age and ICU admission are significant mortality predictors. In settings with a high prevalence of MRSA, factors like age, sex, and quality of care outweigh pathogen-related factors such as antibiotic resistance

Intrafamilial seropositivity of hepatitis in patients with hepatitis B and C virus in hepatitis clinic in Hamadan, Iran

Objective. To determine intrafamilial seropositivity of HBV and HCV and to compare them in families of infected persons with HBV and HCV in Hamadan clinic of hepatitis.Material and methods. In this analytic cross-sectional study, 651 family members of 200 HBV and HCV infection index cases were entered into the study and after signing an informed consent, they were referred to Blood Transfusion Center. With completion of laboratory tests, interviewers filled the questionnaires.Results. One hundred and eighteen (20.5%) and 107 (18.6%) family members were HBsAg and HBcAb positive respectively. 21 (3.6%) were isolated HBcAb positive. Only one person (1.3%) was HCVAb positive. The general rate of infection in family members of HBV infected people (atleast one case) (49.4%) was significantly higher than that of HCV infected people (3.3%), p < 0.001. Interspouses transmission was evaluated and prevalence of interspouses HBV and HCV infection were 32.3 and 8%, respectively.Conclusion. Intrafamilial and interspousal seropositivity of HBV is obviously more than those of HCV. More attention should be paid to screening and risk lowering activities particularly about HBV infected people and their families